The Challenge and Promise of Geriatric Mental Health Training

Abstract

These statements succinctly convey both the problem and the promise for geriatric psychiatry. Despite a growing need for specialists in geriatric mental health—both practitioners and academics—it is not clear where these people will come from, whether they will be sufficient in number, and how their careers will develop. The mental health needs of our rapidly growing older population demand more geriatric psychiatrists and psychologists, clinicians dedicated and trained to ameliorate the burdens of mental illness in late life. We also need researchers committed to understanding these complex disorders and to developing new diagnostic techniques and effective interventions. There are far more topics in need of study than there are investigators in the “pipeline” to do this research. Last, but certainly not least, a cadre of teachers and mentors is needed to train the next generation of geriatric psychiatrists and psychologists and to educate other medical specialties about geriatric mental health. This issue of the Journal strives to provide some practical information, as well as opinion and even inspiration, about training in geriatric mental health. The history of subspecialty certification in geriatric psychiatry provided by Juul and Scheiber 3 helps us understand the progress the field has made in terms of numbers of board-certified geriatric psychiatrists. As of the 2002 examination, nearly 2,600 (of the approximately 3,700 who have taken the examination) have been certified. Although some feel that too few geriatric psychiatrists have chosen to recertify after their certificates have lapsed, the authors point out that the proportion of geriatric psychiatrists recertifying (approximately 65%) is higher than the comparable proportion of geriatric medicine-certified internists (42%) and family practitioners (50%) who have recertified. Thus, depending on one’s perspective, the glass is either half full or half empty. We are fortunate in this issue to have perspectives on fellowship training in both geriatric psychiatry 4 and geriatric medicine; 5 these two articles complement each other in describing the evolution and current state of geriatric specialty training. Lieff and colleagues discuss the results of a cross-sectional survey of U.S. geriatric psychiatry fellowship programs. Several findings stand out. First, over 40% of program directors were relative newcomers to their positions (4 years or less). Also, only 22% of the programs offered training beyond the required 1 year. Finally, program fill rates have declined; this is related to an increase in the number of available positions at the same time that the absolute number of fellows has remained stable. Bragg and Warshaw, in their report