While estimates of the incidence and prevalence of mental disorder in the elderly
vary, the consensus is that the need for services will remain unmet in the
foreseeable future and geriatric mental health programs will continue to be
seriously underfunded. Because of this, older people in general are treated in more
restrictive and less appropriate settings than are younger mentally disturbed
persons. The coming of DRGs and R UGs, the new prospective methods of health
care reimbursement, are likely to compound this potentially lethal situation. It has
been suggested that the implementation of these systems will produce an
underfunding of psychiatric care that will create strong incentives to limit further
both in- and outpatient mental health services to older people. The manner in
which this may occur is the main focus of the article. Alternative models to acute
care and DRGs for mental health care of the elderly, and their respective assets and
liabilities, are also presented.
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