The upcoming White House Conference on Aging, and its forerunner, the Mini White House Conference on Mental Health and Aging, are the kind of events which often produce a great deal of excitement and activity, but whose consequences seems fleeting. A historical perspective provokes some unavoidable cynicism about these events. Many of the recommendations concerning mental health from the last White House Conferences in 1981 never got beyond the confines of task forces and committees. Yet there has been one momentous change since the last White House Conference, the inclusion of psychologists in Medicare.
The challenge that this change poses for those of us concerned with aging is to develop more fully the structure necessary to support the development of highly skilled practitioners of Clinical Geropsychology, that is, to provide opportunities at every level of education to learn the scientific foundations and applied knowledge of Geropsychology.
Since the last White House Conference, Geriatric Psychiatry has emerged as a dynamic subspecialty that attracts many bright young psychiatry residents into practice and research. Underscoring the growth of this field, there is a new American Journal of Geriatric Psychiatry, as well as two noteworthy international journals. As much as many of us might resist the notion, Geriatric Psychiatry's success over the past decade might serve as a model for Psychology. What lessens might there be?
Psychiatric training is generally more centrally integrated into health care and mental health settings than Clinical Psychology, at least prior to the internship. Psychiatry's greater presence leads to greater acceptance in a variety of settings, as well as research opportunities for faculty and students. More flexible boundaries between Psychology Departments and service settings, including the clinicians in those settings, would be refreshing. A two-way effort could lead to better establishment of Geropsychology in many settings, while enriching academic training and research.
Another spur to its growth is that Geriatric Psychiatry has taken advantage of the mechanism of KO7 grants from NIMH--Geriatric Mental Health Training Awards, to build a cadre of young, committed, and well-prepared clinical researchers. These grants were originally available only to psychiatrists and nurses, but psychologists are now eligible to apply.
One of the critical aspects of these grants is that institutional support needs to be available to help candidates build a productive research career. Successful applications in Geriatric Psychiatry have included careful plans for mentorship and training. As a result, awardees have been able to go on to successful research careers at the completion of the training program.
The interest from psychology has been surprisingly low so far, according to Dr. Barry Lebowitz, Chief of the Mental Disorders of the Aging Branch at NIMH. Furthermore, those psychologists who have been successful in their applications to date have tended to have medical school appointments. These training grants could be a valuable resource to build a cadre of committed young clinical researchers, as Geriatric Psychiatry has done, but it needs to be done with the same willingness to commit resources to building careers.
As we look to the future, a vital Geropsychology, integrated with its historical foundations in research, and innovative in clinical practice and research, would be a wonderful outcome a decade from now at the next White House Conference.
To direct comments about the information contained in these pages, please write to marsiske@ufl.edu