The pursuit of a nursing career is driven by a desire to help people, and for many nurses this equates to the nurse–patient relationship in the clinical environment. Yet, nurses also positively impact health outcomes through policy advocacy and action at the population health level in work roles and volunteerism. The influence of nurses in population health advocacy is less visible than the influence in clinical nursing; however, it is equally important to the mental health and well-being of the older adult population.
Mental health disorders, such as depression, posttraumatic stress disorder, anxiety, schizophrenia, and substance use, are problematic to older adults with other medical conditions. Resources to care for older adults with mental health challenges are often limited or lacking. Illness and lack of resources, in combination, complicate treatment, contribute to reduced quality of life for patients and families, and may lead to premature death. Nurses can influence the health and well-being of the older adult population facing mental health challenges by joining the front lines of health policy and politics, advocating, and taking action to create positive change, beyond the bedside.
Barriers at the Intersection of Health Policy, Mental Health, and Old Age Stigma
The stigma surrounding a mental health diagnosis presents a barrier to treatment (Substance Abuse and Mental Health Services Administration [SAMHSA], 2017). Older adults may be reluctant to seek professional help due to embarrassment and fear of discrimination. A unique challenge in older adults is the misconception that depression is a natural part of the aging process (SAMHSA, 2017). Effective mental health advocacy and education can help older adults overcome barriers and seek treatment.
Estimates indicate that approximately 20% of adults 65 and older have one or more mental health or substance use conditions (Institute of Medicine [IOM], 2012). Treatment may be hindered due to limited resources. The rate that specialists in geriatric mental health care enter the workforce as health care providers is minimal in comparison to population growth (IOM, 2012). The IOM (2012) recommended policy changes include incentivizing new providers to seek specialization in geriatric mental health to enhance the workforce to meet the needs of the growing older adult population.
Funding to train primary care providers is essential to improving recognition and treatment of mental health disorders that do not represent normal aging. Older adults seek care largely through primary care providers, who may not screen, diagnose, or refer for further care (SAMHSA, 2017). The IOM (2012) determined that financial support for mental health training is inadequate and called for Congress to appropriate funds to improve training for health care workers, including RNs, to effectively treat older adults with mental health and substance use disorders. A growing population, an undersized geriatric provider work-force, lack of funding, and the need to eliminate stigma converge to create an opportunity for mental health nurses to advocate for change at the population health level.
The Triple Aim as a Framework for Advocacy
The Triple Aim framework, which illuminates the optimization of health system performance, focuses on efforts to improve the care experience, reduce the per capita costs of health care, and improve the health of populations (Berwick, Nolan, & Whittington, 2008). The Triple Aim serves as a reminder for advocates to promote quality care that meets high standards, champion increased access to care, and urge policy makers to support initiatives that enhance the quality of and access to care, while lowering costs.
Advocacy Takes on Many Forms, Beyond the Bedside
Advocacy is an important means of raising awareness on mental health issues and ensuring that mental health is on the national agenda of governments. Advocacy can lead to improvements in policy, legislation, and service development (World Health Organization, 2003).
Viewed as the most honest and ethical group of health professionals (Brenan, 2018), nurses are natural educators and advocates. They raise awareness of older adult mental health issues, challenges, and opportunities, and defend policies and practices that serve the best interests of patients while influencing, impacting, and shaping change. There are many advocacy opportunities that can be explored.
Surf the Internet and Develop an Advocacy Pathway
The internet provides, at the fingertips, low-cost access to a wealth of resources to learn about and become engaged, effective advocates. Through searching, sifting, reading, and absorbing, nurses gain insights that support the opportunity for rich engagement—informing, persuading, and impacting the perspectives of those who develop and implement service-related guidelines and create, enforce, and interpret legislation, laws, regulations, and policies. Each nurse should identify an advocacy pathway that suits his or her energy level, passions, time availability, financial resources, and commitment to older adult mental health.
Collaborate With Advocates from Multiple Disciplines via Coalitions
Older adult and mental health coalitions provide a pathway for joining with a collective voice. The Leadership Council of Aging Organizations (LCAO; n.d.), a coalition of non-profit organizations, advocates in one voice, with one message, on issues that impact older adults. Seventy organizations, such as AARP, Alzheimer's Association, The Gerontological Society of America, and Visiting Nurse Associations of America, cultivate communication and resource sharing, provide information, unite for advocacy, and provide leadership and vision on aging issues. LCAO's focus is broad, yet many of its efforts touch on health and psychosocial issues such as advocating for more affordable medication and more accessible health care. The National Coalition on Mental Health and Aging website (access http://www.ncmha.org) lists state and local coalitions that provide opportunities for geriatric mental health advocacy.
The Nursing Community Coalition (n.d.) comprises >60 member organizations from practice, research, education, and regulation, including the American Psychiatric Nurses Association, Gerontological Advanced Practice Nurses Association, and the National Council of State Boards of Nursing. Member organizations provide Congressional testimony; participate in Congressional and administration meetings; and draft and circulate letters and statements to support important initiatives, such as increasing federal appropriations to fund nursing initiatives and achieving permanent authorization for advanced practice nurses to prescribe medication-assisted treatment to improve access to care for opioid misuse.
Join and Engage in Non-Profit Organizations
Individual nurses can influence and impact federal, state, and local policy by joining nursing, aging, and mental health membership organizations. As dues-paying members of non-profit organizations, nurses can join councils and committees, such as government affairs or government relations, to collaborate with peers to chart the best courses for their organizations' advocacy activities. As members gain understanding and take on leadership roles, they may volunteer or be appointed to be the organization's representative to one or more of the aforementioned or other coalitions.
Stay Up to Date on Issues, Current Events, and Candidates
By staying current on issues and candidates through tracking local, state, national, and international news and attending campaign and political gatherings, nurses can become well-informed and better prepared to engage in meaningful conversation and effective advocacy. Increased understanding translates into a more well-rounded perspective.
Pursue Opportunities to Create Change
Nurses can be influential and impactful change agents at the population level. By voting in primaries and general elections, nurses use their voices to influence who is elected and how resources are allocated. By campaigning and giving time and financial contributions to candidates who are advocates for enhancing older adult mental health services and policies, nurses serve the interests of patients. By meeting with elected officials and their staff to educate, nurses influence the direction of legislative votes. By commenting on rules and regulations as they are in development, through websites such as www.regulations.gov, nurses contribute to shaping rules that guide practice. By running for office, nurses lead instead of being led. The number of Gen Xers and Millennials seeking and being elected to office is trending upward (Desilver, 2018).
Practice to the Full Extent of Education and Training
The American Association of Colleges of Nursing (2011) recognizes the importance of health policy knowledge and engagement as evidenced in the Essential Series, which guides Bachelor's, Master's, and Doctoral education curricula. Nursing students today are exposed to health policy and advocacy course content. For those educated in a program with no such content, there are opportunities to explore policy conferences and webinars that focus on state and/or federal advocacy and teach participants to maximize the power and effectiveness of their voices and practice to the full extent of education and training to lead change and advance health.
The collective voice of the >4 million U.S. RNs and licensed practical nurses (National Council of State Boards of Nursing, 2019) can and should be strong, informative, and impactful. There is no time like the present for nurses to learn, develop an advocacy pathway, join and engage in organizations, collaborate, stay current, be change agents, practice to the full extent of education and training, polish presentation skills, gain confidence, and step-up and lead (Falk & House, 2014).
What next step can you take today, as a curious, caring, compassionate, communicative, convincing, credible mental health nurse, to expand understanding and skills to make an even greater impact on patient care, advocating on behalf of the older adult population? Select one step today to begin a new advocacy journey beyond the bedside.
- American Association of Colleges of Nursing. (2006–2011). The essentials series. Retrieved from http://www.aacn.nche.edu/education-resources/essential-series
- Berwick, D.M., Nolan, T.W. & Whittington, J. (2008). The triple aim: Care, health and cost. Health Affairs, 27, 759–769. doi:10.1377/hlthaff.27.3.759 [CrossRef]
- Brenan, M. (2018, December20). Nurses again out-pace other professions for honesty, ethics. Retrieved from https://news.gallup.com/poll/245597/nurses-again-outpace-professions-honesty-ethics.aspx
- Desilver, D. (2018, November21). Millennials, Gen X increase their ranks in the House, especially among Democrats. Retrieved from https://www.pewresearch.org/fact-tank/2018/11/21/millennials-gen-x-increase-their-ranks-in-the-house-especially-among-democrats/
- Falk, N.L. & House, M. (2014). Don't come late to the party: Step up and lead. Contemporary Nurse, 48, 133–134. doi:10.1080/10376178.2014.11081935 [CrossRef]
- Institute of Medicine. (2012). The mental health and substance use workforce for older adults: In whose hands? Washington, DC: The National Academies Press.
- Leadership Council of Aging Organizations (n.d.). About LCAO. Retrieved from https://www.lcao.org/about-lcao
- National Council of State Boards of Nursing. (2019). The National Nursing Database. Retrieved from https://www.ncsbn.org/national-nursing-database.htm
- Nursing Community Coalition. (n.d.). About NCC. Retrieved from https://www.thenursingcommunity.org/core-principles
- Substance Abuse and Mental Health Services Administration. (2017). Linking older adults with resources on medication, alcohol, and mental health. Retrieved from https://store.samhsa.gov/system/files/sma03-3824.pdf
- World Health Organization. (2003). Advocacy for mental health. Retrieved from https://www.who.int/mental_health/policy/services/1_advocacy_WEB_07.pdf?ua=1