Transportation providers serving older adults, people with disabilities, and caregivers understand that transportation is vital to the health of their riders, but often health is thought of in broad terms, and mental or behavioral health gets overlooked. Yet statistics show that behavioral health, a term which encompasses both mental health and substance use disorders (SUDs), is a large and growing concern among older adults and people with disabilities, particularly since the COVID pandemic.
Credit: Capacity Builders, Farmington, NM
How Big is the Issue?
Experts say that behavioral health issues among older adults and people with disabilities, particularly individuals with substance use disorder, often go undiagnosed. For example, doctors treating a patient for chronic pain may overlook the patient’s misuse of pain medication.[1]
Statistics on Behavioral Health of Older Adults and People with Disabilities
- At least 1 in 4 older adults experiences some mental disorder, such as depression, anxiety, or dementia, and the number is expected to double by 2030.
- Two-thirds of older adults with a mental disorder do not get the treatment they need.
- 7 million people (about 12 percent of persons aged 65 and older) in the U.S. live with Alzheimer’s dementia.
- People aged 85 and older have the highest suicide rate of any age group.
- 11 percent of older adults with any mental illness in the past year also had a substance use disorder (SUD). Less than a quarter, 23 percent, of SUD treatment programs in the U.S. offer services tailored to the needs of older adults.
- For any substance use disorder in adults aged 55 and older in 2004-2005, the prevalence for specific racial and ethnic groups was as follows: 3.9 percent for non-Hispanic Whites; 3.6 percent for African Americans; 3.3 percent for Hispanics, 3.0 percent for American Indians/Alaska Natives; and 1.7 percent for Asian/Native Hawaiian/other Pacific Islanders.
- Prevalence of reported mental distress among people with disabilities is 32.9 percent, 4.6 times the prevalence for persons without disabilities (7.2 percent).
Sources: 2023 Alzheimer’s Disease Facts and Figures; Pan American Health Organization, Seniors and Mental Health; SAMSHA, Treating Substance Use Disorder in Older Adults, 2020
A number of transportation providers have expanded their community partnerships to provide access to the full array of healthcare services, including behavioral health services, needed by their riders. Their programs are described below. Information provided was collected through interviews with each of the agencies.
Mass Transit Authority (MTA), Flint, Michigan—MTA Rides to Wellness is a comprehensive, non-emergency medical transportation (NEMT) program that provides mobility management, door-to-door service, and same day service for riders, including older adults and people with disabilities, going to medical or other health and wellness-related appointments. The program began in 2016, and MTA currently serves three behavioral health providers that cover the ride cost for their clients. MTA communicates closely with these providers to meet their clients’ needs, which is particularly important when scheduling group rides and managing the “no show” rate. While MTA’s public transportation rides decreased dramatically during the pandemic, MTA Rides to Wellness and its behavioral health rides held steady and even increased.
MTA collects feedback cards from riders and receives positive comments from behavioral health providers about the value of its program. MTA Rides to Wellness works, and behavioral health providers welcome the service for their clients.
Envida, Colorado Springs, Colorado—Envida, a nonprofit human services provider, has long served older adults, people with disabilities and caregivers, transporting them to medical appointments, dialysis, adult day programs, volunteer activities, grocery and shopping, and more. Drivers meet federal and state requirements with Passenger Assistance, Safety and Sensitivity (PASS) training. They also learn quickly on the job how to relate with riders who have dementia-related illnesses.
Beginning in 2018 Envida developed and added partnerships for behavioral health rides including substance use disorders. Envida provides transportation to people with chronic mental health and substance abuse to behavioral health counseling and support, routine and specialty medical services, and critical treatment. Some drivers have taken additional training in Mental Health First Aid, Trauma-Informed Care, and Narcan administration. Envida also launched web-based and mobile applications for scheduling rides and checking on ride status that proved particularly helpful to riders with behavioral health concerns.
Envida’s model organizes transportation services and healthcare delivery to support appropriate transit options from crisis to intervention to discharge home. In fact, in one survey, their provider partners all agreed or strongly agreed that Envida’s services improved clients’ continuity of care. Moreover, 71 percent of behavioral health clients attended all follow-up appointments.
Vermont Agency of Transportation (VTrans), Barre, Vermont—In 2017 as the opioid crisis tightened its grip in the Northeast, the Governor of Vermont organized an advisory council that included public health and VTrans. The result has been an ongoing statewide, coordinated effort that includes funds to help all ages access substance use disorder treatment, recovery classes, drug testing, jobs, and more.
VTrans continues to evolve its transportation network as it seeks mobility for all. For decades it has offered fixed transit, paratransit and demand-response services for older adults, people with disabilities, and individuals eligible for Medicaid NEMT. The opioid crisis, which was then compounded by social isolation and deferred treatment during COVID, brought additional funds to help all riders access treatment. Ride costs are covered first by Medicaid, then Older Americans Act, and finally state and federal match programs. VTrans also requests assistance from hospitals, adult day programs, and others to cover their costs.
Riders who use VTrans for behavioral health rides tend to be from Vermont’s many rural areas. Because it is often difficult to find space available at treatment facilities in the state, riders must sometimes travel up to two hours to access a facility. Mobility management is often needed to help riders locate and access behavioral health services closer to home. All drivers, whether paid or volunteer, undergo Passenger Assistance, Safety and Sensitivity (PASS) training, which offers some assistance with mental health and SUDs issues, but the staff is considering the need for additional training for these complex rides.
Conclusion
Transportation programs for older adults often serve riders who have dementia and cognitive-related illnesses, while transportation programs for older adults, people with disabilities and caregivers regularly provide rides to medical appointments for physical health. Evidence suggests a growing need for transportation to other behavioral health treatments, including substance use disorders.
Local transportation programs interested in expanding their services to better meet the needs of people with mental health can learn from the experience of the programs showcased here, which show that mobility management, special driver training, and mobile applications may be needed. One common thread among the programs is partnering with behavioral health providers and substance abuse recovery programs to ensure that older adults and people with disabilities have access to their services.
This blog post was written by David Somers, Senior Research Associate at NADTC and USAging.
[1] Alliance for Aging, Substance Use Disorders & Mental Health in Older Adults
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