The iPad Therapist: Mental Health for the Aging

March 17, 2014

By Matt Perry

Davis Park stands in front of 11 older adult residents of the Los Angeles independent living facility Good Shepherd Manor – all but one of them African-American – and asks what they know about technology.

“How many of you know what videoconferencing is?”

One hand rises.

How many know how to use a computer? Three hands rise. How many want to know how to use a computer? More hands go up.

Head of the Front Porch Center for Innovation and Wellbeing, Park is visiting the modest facility’s dining room to kick off a cutting-edge behavioral health pilot program aimed directly at low-income, minority populations: telemental health.

By offering computer-based therapy sessions, telemental health has a promising future for older ethnic adults who face an uphill battle accessing services for common problems like depression and anxiety.

Some seniors have trouble simply getting transportation to visit a doctor or counselor. Others face the stigma of mental health treatment. Add the barriers of language, culture and race, and seeing a therapist can become a nearly impossible task.

“We know this is an important issue among low-income communities,” says Park. “There tends to be less access to social services and mental health services.”

Social isolation and loneliness can increase depression, pessimism, substance abuse, and sleeplessness. It can also deplete the body’s immune system, increase blood pressure, and speed the progression of Alzheimer’s disease.

Launched in February, the telemental health initiative is being introduced in three Los Angeles-area sites, each with a unique ethnic makeup. Good Shepherd houses mostly African-American tenants; the Vista Towers low-income retirement community serves Asian and Pacific Island residents, mostly Korean; finally, the ERB Foundation is the only community center of the three, and serves Filipino veterans of World War II (and their families), some of whom are in their 90’s and suffer from PTSD.

Park says that Good Shepherd Manor has a high incidence of substance abuse, alcoholism and depression. Danielle Johansen, the site’s resident services manager, says the lack of family connections often cause acute social isolation.

“They do want to stay in their homes most of the time,” she says.

One resident says it’s heartening to know that facility administrators care enough to offer telemental health. (CARING Housing Ministries, a subsidiary of Front Porch, manages the Good Shepherd and Vista Towers residences; together, the two operate over 30 senior living communities.)

“In the time we’re living, it feels like nobody’s listening,” says Lela, who offers only her first name and age at “over 60,” with a smile. “And they feel like having someone listen to them.”

The goal of the pilot program – called the Model eHealth Community for Aging, or MeHCA – is to treat 10 clients from each of the three sites.

The first session between a therapist and client will happen in person. After that, clients will use iPads to video conference with counselors either in a private setting within the facility or take the device back to their home.

Each will receive 10 hours of counseling in their preferred language: English, Spanish, Korean or Tagalog.

At Vista Towers, the API community – Asian and Pacific Islanders – presents a unique challenge for mental health services, says Yvonne Sun, who leads the outreach at the Koreatown site.

“The level of stigma is very prominent in the community,” says Sun, older adult division director for Special Service for Groups. “They see receiving mental health services as a reflection of their entire family unit.”

Despite the need for mental health services in API communities, Sun says there is still tremendous shame attached to the process.

‘There’s a lot of education that needs to happen.”

The telemental health initiative comes on the heels of another digitally-based Front Porch project targeting physical health. Following telehealth consultations, patients uploaded data from scales, blood pressure cuffs, and glucometers that were assessed by remote nurses in Buffalo. Afterwards, 86% of the patients in the program reported a better understanding of their health, along with “significant improvements in self-reported health and declines in blood pressure,” according to Park.

Funded by last year’s small $25,000 grant from the aging advocacy group LeadingAge, the telemental health initiative weaves together more than 20 organizations, many of them offering services pro bono.

In California, there are fewer than 20 current telemental health programs operated by large professional organizations, says MaryAnn Frattarole of USC Telehealth, which is donating all but 5% of its services to the initiative.

USC has fostered several telemental health successes, including a rural Latino client who lives several hours away from the nearest Spanish-speaking therapist.

The goal of the initiative is to show that telemental health works in underserved communities – and to find a sustainable payment method.

The kickoff at Good Shepherd Manor proves a resounding success. Johansen says that 10 of the site’s 144 residents signed up to express interest in the mental health initiative.

Park says the ultimate goal is to expand such mental health initiatives far beyond these three communities – including others operated by Front Porch and CARING Housing Ministries – then beyond.

“The populations we want to target are not just in these affordable housing communities.”

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  1. Pingback: California Health Report: The iPad Therapist: Mental Health for the Aging |

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