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Sarah Mogzec asks the group of 10 seniors to find the courage to tell their adult children or grandchildren, "No."
Someone may be asking them for money or a place to stay. They have a right, the licensed clinical social worker tells them, to take time and do what's best for their own long-term goals.
"Oftentimes children, [a] grandchild will come to you and say, 'I need some money and I need it now.' It's OK to say, 'I need a couple of days to kind of think this through and see if this is something that is going to work for me, too,'" she said Wednesday.
Mogzec is helping folks at River's Bend Senior Center in Salt Lake City think through their evolving roles with their family members.
It may not be obvious, but she's also helping them weather the difficulties that can lead to depression and anxiety in older age.
Such classes called "vital aging" instead of "therapy" to avoid scaring seniors away are one way Salt Lake County agencies are trying to provide mental health services to seniors, many of whom struggle but are less likely than younger adults to seek help.
It's an effort that is about to expand: For the fiscal year starting July, the county will more than double the amount of money it spends on mental health services to seniors, allocating $260,000.
'A huge unmet need' • Details of how the money will be spent are still being worked out. But it will go to Valley Mental Health's Masters Program, which offers therapy and education to adults 55 years and older.
Valley wants to copy successful programs from Washington and Colorado, where postal workers, bus drivers, restaurant and retail staff are trained to spot seniors who may need help. The extra money will come from county mental health funds used to help the uninsured. It will also help boost the Masters program, which lost half of its staff last year.
"There's a huge unmet need for mental health services in seniors," said Sarah Brenna, the county's director of aging services. "It's not a population that we think of often in terms of needing some support."
Older adults have higher rates of suicide. And about 20 percent have a mental health problem but don't get help, according to the Substance Abuse and Mental Health Services Administration.
The conditions of old age may seem ripe for depression health declines, family and friends pass away, finances are tight, identity shifts and feeling sad is normal. But persistent depression that interferes with one's ability to function is not, according to the National Institute of Mental Health.
"That's one of the fallacies that's perpetuated oh, they're old, they should be depressed," said Fred Van Der Veur, program manager of Valley's Masters Program. "It's a disorder that can be treated with medication and psychotherapy so the individual can feel much more empowered and feel like they have a right to feel which is enjoying themselves and their stage of life."
He said some 530 seniors participate in the Masters program. They mainly seek help for depression and anxiety related to the developmental challenges of old age. There's also a segment that have had chronic mental illness all their lives.
But with Utah's growing aging population, seventh fastest in the country, Van Der Veur says more could use mental health services.
'Develop a rapport' • It's the stigma that stops seniors from seeking help. Unlike the generation providing nonstop status updates on Facebook and Twitter, self-disclosure does not come easily to people who suffered through the Depression and sacrificed during World War II.
Van Der Veur describes their attitude as "'We take care of ourselves and we're strong.' They're more prone to believe the suffering is part of their character and ... this is just the way it is."
Therapists have to find different ways of reaching out to seniors. That's why the Masters program started in seven county senior centers in 2009. They offer what they call "classes" on topics including loneliness, dealing with retirement and staying well with exercise and nutrition. But "they really are psychotherapy groups," said Rhonda Busch, a licensed professional counselor who coordinates the courses.
Nearly 200 seniors attend each month. "They don't view us as intimidating mental health therapists," Busch said. "We get to know them individually and develop a rapport with them."
Mogzec, Valley's social worker at River's Bend, said the classes "provide an environment where people can express their feelings and concerns and their worries. A lot of them don't have anybody else to talk to."
Annette Betts, 70, has been attending the classes for three years. Aging, she says has "been hard. I feel like I don't see my children often enough. I wish they'd come visit more. I think we all feel that way."
She says more of her peers should seek out such resources at senior centers. "I don't think people know. I feel badly for people who are lonely. They can benefit by coming."
'You have to be a survivor' • A common refrain among seniors at the center, whether they sought therapy or not: Making friends and activities from volunteering to playing poker to exercising helps them weather the ups and downs of old age.
While learning how to use a computer so she can research her genealogy, Herminia Calautti, 82, said the classes have taught her to be patient with her physical struggles.
"I try to do exercises at least three times a week to keep my legs strong to go upstairs to my bedroom. I live alone and try to be independent and try not to be a burden to my family. ... Sometimes I say I want to be 20 years younger, but that is impossible."
Joe Ross, 76, said he sometimes thinks of dying and "how many days it will take before somebody came to find me," since his children live in California and his wife died several years ago.
But he plays poker three times a week at the center, he's joined its Wii bowling league, he gardens and walks his dog.
"We don't have time to think about these things that can mentally deteriorate you," he said, taking a break from the card game.
About a decade ago, Kay Kenner attended Masters grief counseling sessions when four people, including her husband, died within two years.
"You have to be a survivor," she said, adding that at 79, she enjoys her age and joining in center activities. She feels like a teenager again, but without parental supervision.
"It's a different part of our lives. You turn a corner. I'd never want to go back. ... It's really a more independent life" than when she was raising a family and working.
River's Bend, adds friend Elaine Peterson, 86, is "good therapy... When you stay home all the time, you become a nobody. [At the center] you're able to be around people your own age and they understand you."
Keeping a look out • But mental health officials acknowledge many seniors don't go to centers or have other resources.
Valley and the county are looking at replicating The Gatekeeper Program developed in Spokane, Wash., and the Senior Reach program used in a five-county region in Colorado.
In both programs, nontraditional "referral sources" from bank and utility employees to postal carriers and apartment managers are trained to refer older adults who appear to have problems. Signs might include dirty or missing clothing, a calendar on the wrong month, a dilapidated home or confusion.
In Colorado, 30,000 people have been trained. Vicki Rodgers, a vice president at the Jefferson Center for Mental Health,said helping about 200 seniors a year allowed them to stay in their homes; depression can lead to faster physical deterioration.
In fact, a study published this month in the Archives of Internal Medicine found seniors who reported feeling lonely were more likely in the following six years to become physically disabled and die.
With early help, "people don't have that level of disability that gets them to a place where they can't live independently anymore," Rodgers said.
Suicide among older Utahns
About 35 Utahns 65 years and older die from suicide each year.
Another 52 are treated in an emergency room or hospitalized after a suicide attempt, most often from poisoning.
Utah's older adult suicide rate is 14th highest in the nation, at 12.6 per 100,000 population in 2009. The national rate in 2007 was four.
Older Utah adults who died were more likely to have physical health problems than younger Utahns who committed suicide.
Older adult females were more likely to have experienced a death in the family or of a friend.
Source: Utah Department of Health's "Older Adult Suicide in Utah, 2005-2009" report.
Signs of depression
Talk to your doctor if you:
Feel nervous, empty, worthless, restless, irritable, unloved, that you don't enjoy things you used to or that life isn't worth living.
Sleep or eat more or less than usual.
Source: The National Institute of Mental Health