The Elder Justice Roadmap

Facilitated Discussion on Diminished Capacity and Mental Health
“Conceptualizing mental health and capacity issues as "brain health and functioning" is
ground breaking. Clearly, diminished capacity and mental health are part of brain health
and function. If the brain is not functioning properly, it can lead to impairment and lead to
trouble making decisions. Calling it “brain health and functioning” also helps ease people
into the conversation.”
– Diminished Capacity/Mental Health FD Participant
Discussion participants:
Jason Karlawish, MD, University of Pennsylvania
Octavio N. Martinez, Jr., MD, MPH, MBA, FAPA, Hogg Foundation for Mental Health
Willard Mays, MA, American Sociological Association (ASA) Mental Health and Aging Network
Alixe McNeill, MPA, National Council on Aging
Harry Morgan, MD, Center for Geriatric and Family Psychiatry
Elizabeth J. Santos, MD, University of Rochester School of Medicine and Dentistry
Jo Anne Sirey, PhD, Weill Cornell Medical College
Susan Wehry, MD, Vermont Department of Disabilities, Aging & Independent Living
For decades, researchers and practitioners working with older victims and abusers have identified
diminished cognitive capacity and mental health problems as critical and complex issues in relation to
elder abuse. Yet both issues – standing alone and the interplay between them – are often not well
understood or addressed in efforts to prevent, address, and understand elder abuse.
Priorities:
Brain health and function: Participants supported efforts to examine diminished cognitive
capacity and mental illness in the context of elder abuse, through the framework of brain health
and functioning. Such language could help to de-stigmatize the issues of mental illness,
substance abuse, dementia, and diminished cognitive capacity, and create natural bridges among
the mental health, substance abuse, dementia, and elder abuse fields.
Education regarding the use of assessment tools: Many practitioners on the front lines still use
outdated instruments to assess diminished cognitive capacity and screen for mental health
problems. We need to develop a standardized curriculum for front-line responders on what tools
are validated, how to use them to assess cognitive impairment, decision-making cognitive
capacity, depression, and anxiety, as well as to provide supervision and support.
Integration: Key professional, consumer, and government agencies that address mental health,
substance abuse, and dementia should integrate elder abuse concerns into their policy, practice,
training, and research priorities.
The Elder Justice Roadmap–Appendices 36