California agency creates mental health program for the aging

by Laurie L. Hayes

Counseling Today

America's baby boomers are coming of age — old age, that is.

With a member of the baby boom generation (those born between 1946 and 1964) turning 50 every eight seconds, our nation's elderly population is growing at a rate that is unrivaled by any other age group. According to the U.S. Bureau of Census, in the next 25 years or so, one in five people in this country will be included in the ranks of senior citizens.

The patriarchs of this population are increasing their numbers at an even faster rate. By 2020, there will be a projected 7 million individuals aged 85 years and older — double the total in 1994 — and a special Census Bureau study noted that this number is expected to triple or even quadruple by 2050.

Tremendous strides in medical science in recent years have greatly extended the life expectancy in this country. But conquering, or at least postponing, the physical effects of aging is really only half the battle in improving the lives of our nation's elderly. According to the American Psychiatric Association, between 15 and 25 percent of the senior population in the United States suffer from significant signs of mental illness — symptoms that go largely untreated, either hidden, ignored or simply blamed on old age.

An organization based in San Francisco is, however, working to change this unfortunate reality. The Pacific Institute, a family-run, nonprofit agency dedicated to the development of a comprehensive mental health care program for older Americans, is already showing promising results in its innovative approach to elder care.

Current projections indicate that approximately 60 percent of people 75 and older will require some form of long-term care, and many will need to be placed in assisted living facilities. Recognizing this, the Pacific Institute is working to ensure that those seniors receive adequate care for not only their bodies, but for their minds and spirits as well.

"One in five elderly suffers from depression, and cases of Alzheimer's and dementia will nearly double in the next 15 years," said Amir Kia, one of three brothers who founded the Pacific Institute. "We believe that mental health care for the elderly is no longer an optional service. Now more than ever, we must challenge the stigma to make it a necessity."

Kia said the Institute — found online at — was the brainchild of his oldest brother, Nader Robert Shabahangi, a licensed psychotherapist. "Nader started Pacific Institute in 1991 to provide mental health services to California's underserved populations," Kia said. "It has since evolved into an agency focusing on gerontological mental health concerns."

Through the Pacific Institute, Kia said, the brothers have combined their skills to search for the best way in which to provide holistic support for the elderly population to lead healthier and more meaningful lives.

With this purpose in mind, the Institute has identified the following objectives for the gerontological services it offers:

  • Create a home environment for the residents to enjoy and appreciate;
  • Address residents' emotional, physical and spiritual concerns as they arise in their new environment;
  • Help new residents adjust to their situation in an assisted living environment;
  • Facilitate the personal and communal unfolding of residents' talents and abilities by assisting in the continued exploration of residents' individual meaning and purpose in the latter part of their lives;
  • Create a harmonious sense of community and well-being throughout the facility;
  • Monitor potential crisis situations, assisting in the understanding of their origin and in helping the residents through crisis; and
  • Educate and counsel residents and their families as needed.

The Institute is run by a professional staff headed by Clinical Director Padma Catell, who is also the assistant dean of the School of Professional Psychology at the California Institute of Integral Studies. With the help of a licensed clinical supervisor, a clinical coordinator and other administrative staff, Catell oversees the Institute's internship program, which is instrumental in the application of the Institute's principles and objectives.

Students at both the master's and doctoral level participate in the program, which is run out of Hayes Valley Care, a state-licensed, live-in care facility for seniors, also owned and operated by Kia and his siblings. Founded in 1995, Hayes Valley Care houses 47 residents in a restored Victorian home in the cultural center of San Francisco. The level of services available is based on the resident's needs and ranges from assistance with activities and daily living to continuous care, supervision and monitoring. All, however, are afforded access to some form of mental health counseling.

"Our population is pretty complicated," Catell said. "And the interns deal with all of the pieces, from helping people accept and adjust to the move to a residential facility to treating a lot of depression and dementia."

The eight interns at Hayes Valley Care devote 20 hours per week to the internship program, which includes supervision and didactic, as well as contact time with residents, family members, staff and other involved professionals.

"Each intern has four or five residents who are their primary responsibility," Catell explained. "But we pay close attention to the distribution of people, so that the mental health needs are somewhat balanced and no intern is dealing with only dementia or some long-term mental illness."

Interns are required to maintain a folder that summarizes their assigned residents' specific needs and concerns, including case notes for all. They participate in case conferences on issues related to individual residents. They may even be called on to offer support and counseling to the families of residents if deemed appropriate.

Interns are also responsible for leading a variety of groups and activities, which are open to all residents and must be designed to accommodate all levels of functioning. The aim of these activities is to provide stimulation and exercise, opportunities for personal growth and self-understanding and community building.

In addition to more traditional counseling endeavors, these may include scenic drives, picnic lunches, poetry groups, sing-a-longs, cultural field trips and even full-day trips to destinations convenient to the city.

"It truly is a good placement for the students," Catell said, estimating that more than half eventually devote their careers to working with the geriatric population. "They get an interesting combination of training in both mental health counseling and geriatrics. Most of our interns like and stay with the program even after graduation."

Inspired by positive feedback from residents, family members and interns, the Pacific Institute began working with San Francisco city officials several years ago to develop a pilot program for low-income elderly residents who require mental health care.

Until the Institute's intervention, many poor elderly individuals with psychological problems were institutionalized in locked wards because of a lack of more appropriate options. This amounted to huge expenses for the city and did little to help the condition of these seniors.

The Institute's Residential Community Mental Care for the Aging program offered a solution to this problem by integrating 13 of these most challenging clients into Hayes Valley Care's home. Nearly three years later, the program is a resounding success, both for the San Francisco taxpayers and the elderly clients. A recent study showed that the city saved $920,000 over the past 2.8 years by paying a fee to house the RCMCA participants at Hayes Valley Care, rather than using city psychiatric services.

The 13 seniors collectively have had 299 less hospitalization days and nearly 4,500 less locked ward days since being admitted into the program, accomplishments that obviously help the bottom line, but more important, point to marked improvement in the health and well-being of these individuals.

Elke Mendiola, executive director of Hayes Valley Care and a sister to Kia, noted that people need to look no further than a patient named Mary to see the benefits of the program. Mary was in her early 60s when she was admitted into the program, and had spent more than 400 days in the city's Mental Health Rehabilitation Facility.

"We were told that Mary was unable to take care of herself," Mendiola said. "In the institution, she refused to leave her room and was developing sores because she wouldn't get out of her bed."

In spite of the fact that Mary called Nader a "Nazi" at their first meeting and referred to former President Bill Clinton as one of her 40 sons, Mendiola insists that she was "welcomed into the program with open arms."

Upon Mary's arrival, the Pacific Institute's mental health interns began to work intensively with her in individual and group therapy sessions. Within a month, Mary began a remarkable transformation. She stopped talking about delusional events, began to help staff answer phones and even starting dating another resident.

"Her sister comes to see her every day now, after not talking with her for 20 years," Mendiola reported. "She told us she had never seen Mary smile. Now her sister smiles all the time."

Mendiola looks forward to helping more clients like Mary in the near future. She and her brothers hope to expand their operations to include other facilities similar to Hayes Valley Care and vow that they will continue to accept low-income residents into any new homes they establish. They also hope that other residential care facilities will be interested in replicating their program.

"So many facilities offer nothing in the way of mental health care," Mendiola said. "The elderly need more than just a bed. There is so much trauma associated with aging that is not being addressed. We really need to gear up and get ready to better serve this growing population. The availability of professional counseling really makes all the difference."

The staffs of both Hayes Valley Care and the Pacific Institute are willing to help organizations or individuals who would like to start a similar program. "Our goal is to have this type of program at every assisted living facility and available to all community mental health services," said Mendiola.

Obviously the availability of counseling interns is vital to the program's success, as is the availability of a clinical supervisor. But Kia stressed that the benefits reaped from establishing an internship program is well worth the expense and effort involved — both in terms of the care provided and the experience gained.

"In addition to providing a healthier and more meaningful life for our residents, we are training a new generation of mental health professionals to provide gerontological services," Kia said.

Mendiola agreed. "The bottom line is that we are improving the quality of life for an entire generation," she said. "And that really is what it is all about."

Laurie L. Hayes is a freelance writer in Severna Park, Md.