An Oak Street Health physician recently shared a story with me about a patient nearing 90 years old who repeatedly sought care for acute chest pain. She had already visited the emergency department twice that month for similar episodes, and each time, cardiac evaluations came back negative.
Clinicians treated her immediate physical symptoms, but the underlying cause remained unresolved.
Then, during a follow-up phone conversation, the patient revealed something that changed the clinical picture entirely. February marked the anniversary of several devastating family losses she had experienced over the years. The grief tied to those losses had resurfaced intensely, manifesting as anxiety, depression and physical pain. Stress-related gastrointestinal distress likely compounded the symptoms, creating a cycle that repeatedly brought her back into the healthcare system. Notably, once her mental health symptoms were treated by a behavioral health specialist within Oak Street Health, she experienced relief from her physical symptoms.
Stories like this are more common than many people realize. For older adults, mental health concerns frequently present through physical symptoms first — chest pain, fatigue, gastrointestinal issues, insomnia or worsening chronic conditions. In a fragmented healthcare system where physical and behavioral health are often treated separately, the emotional root causes can easily go unnoticed.
The need for better support is growing quickly. Citing statistics from the National Institute of Mental Health, the National Council on Aging points out that 1 in 5 Americans will experience mental illness in their lifetime, and nearly 15% of adults ages 50 or older have some type of mental health disorder.
At the same time, America’s population is aging rapidly. AARP reports that 10,000 Americans turn 65 every day, and adults over 65 are projected to make up more than 20% of the US population by 2050.
Our healthcare system is not fully prepared for what that means.
Systemic barriers continue to limit access
Even when mental health services exist, many older Americans struggle to access them. Research by the NIMH shows that just 53% of adults ages 50 and older with any mental illness received mental health treatment.
The barriers vary — from stigma and insurance complications to transportation challenges and fear of judgment — but the outcome is the same: Too many older adults suffer in silence.
Several systemic barriers contribute to the problem.
Structural fragmentation. Healthcare delivery remains structurally fragmented. Primary care is often the most trusted and accessible entry point into the healthcare system for older adults, yet many primary care physicians lack the time or specialized behavioral health support needed to identify mental health conditions that present alongside physical symptoms. Even when physicians recognize a mental health concern, referral pathways are often difficult to navigate. Older adults may struggle to find Medicare-accepting behavioral health specialists, arrange transportation, navigate unfamiliar technology or coordinate appointments across multiple disconnected providers. As a result, patients can end up cycling through repeated visits for physical symptoms without ever receiving meaningful mental health support.
Cultural and clinical biases. Long-standing cultural and clinical biases affect how mental health is perceived in older populations. Symptoms like withdrawal, sadness, memory changes and anxiety are too often dismissed as a normal part of aging rather than recognized as treatable conditions. This mindset can contribute to underscreening, delayed diagnoses and missed opportunities for early intervention.
Financial friction. Financial barriers add another layer of complexity. Traditional reimbursement structures and Medicare coverage limitations can make behavioral healthcare harder to access, particularly for lower-income seniors. The burden is not evenly distributed. The Pew Research Center has found that while nearly three-quarters of higher-income older adults rate their mental health positively, fewer than half of lower-income older adults say the same.
Taken together, these pressures create a care environment where mental health needs often remain untreated because physical and emotional health are still addressed separately rather than as part of the same patient story.
What integrated care can look like
Patient experiences illustrate what becomes possible when behavioral health support is embedded directly into primary care.
Depression and anxiety are the most common mental health conditions for older adults, according to the World Health Organization — a reality clinicians increasingly encounter in primary care settings. One physician recently described caring for a 72-year-old woman facing a fourth recurrence of stage IV breast cancer. During a routine primary care visit, the patient showed clear signs of depression.
Because her clinic operated within an integrated behavioral health model, her physician did not need to send her through a lengthy external referral process. Instead, a behavioral health specialist joined the visit directly, allowing the patient to receive support immediately in a familiar setting.
The model eliminated barriers such as additional travel, separate intake procedures and the stress of building another unfamiliar provider relationship during an already difficult time.
The stakes become even clearer when considering suicide risk among older adults. CDC data shows men ages 85 and older experience the highest risk of suicide in the country.
Another patient story highlights the importance of proactive mental health screening. A 74-year-old man grieving multiple personal losses — including family members and a longtime companion dog — attended a routine primary care appointment where universal mental health screening was part of standard care.
Although reluctant to discuss his emotions directly, the screening created an opportunity for his physician to begin the conversation. Rather than requiring the patient to independently seek behavioral healthcare elsewhere, the clinic connected him with support services onsite.
These experiences point to a broader reality: Older adults are more likely to engage with mental health services when care is accessible, familiar and integrated into the primary care relationships they already trust.
A more connected approach to care
In many ways, the barriers reflect a uniquely American healthcare challenge. Compared with older adults in other high-income countries, US Medicare beneficiaries with mental health needs are more likely to report cost-related barriers to care, alongside challenges tied to stigma and fragmented access.
For healthcare providers, supporting patients through difficult mental health moments is both a clinical responsibility and a deeply human one. These experiences reinforce how deeply human healthcare is supposed to be — especially for older adults, who are often navigating grief, loneliness, chronic illness and major life transitions simultaneously.
They also point toward a clearer path forward.
Older Americans need access to behavioral health services in the same places where they already receive physical care. Mental health support should not operate separately from the rest of the healthcare experience. It should be embedded within it.
Strong patient-provider relationships are equally important. When older adults trust their physicians, they are more likely to discuss loneliness, anxiety, depression and grief before those issues escalate into crises that are harder to treat. That trust also drives deeper engagement with care — making patients more likely to attend appointments, follow treatment plans and seek support earlier. In turn, stronger engagement can lead to better health outcomes, particularly when behavioral health support is integrated into the primary care experience.
Achieving this at scale will require continued movement toward integrated behavioral healthcare models within primary care, supported by reimbursement structures and value-based care models that recognize the connection between physical and mental health outcomes.
The goal is not to provide more services. It is to build a healthcare experience that is easier to access, easier to navigate and better aligned with the reality that physical and mental health are rarely separate for older adults.
Opinions expressed by SmartBrief contributors are their own.
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