Panel recommends depression education

‘Least knowledgeable people are involved in triage’

Recently, a consensus panel organized by the Chicago-based National Depressive and Manic Depressive Association (NDMDA) convened to assess the state of care for depressive patients and to recommend strategies for improving treatment. The panel issued the following five recommendations:

Enhance the role patients and their families play in managing depression by increasing their knowledge of the disease.

Patients who understand what depression is, how it’s diagnosed, and what the various treatment options are, will find it easier to seek treatment for the condition, says Robert M. A. Hirschfeld, MD, professor and chairman of the department of psychiatry and behavioral sciences at the University of Texas Medical Branch at Galveston and chairman of the NDMDA panel. "An informed patient can say, ‘I’ve heard there are three or seven or 35 different treatment options. Which of these are you capable of providing? And if you can’t provide them, then where can I go?’"

For any therapeutic relationship to be successful, patients must develop partnerships with their caregivers, adds Donna DePaul-Kelly, interim executive director of the NDMDA. "A patient has got to understand about his therapy, whether it be medication, psychotherapy, or whatever and understand all they can about the illness and what they can do to promote their own recovery. Too often, people with depression allow themselves to be the victim. They take the advice, take the medication, but they don’t do enough proactively to get themselves well and keep themselves well."

Develop performance standards for behavioral health care carve-outs and behavioral health care in other organizations.

"When it comes to health care providers, especially MCOs [managed care organizations], consumers really need to know something about how they operate," says Hirschfeld. "For example, in what percent of their subscribers do they find depression? If it’s one in a thousand, you know they aren’t looking very hard; they’re missing a lot. Then you want to know, of the people diagnosed with depression, how many come back for second visits? What percent get medication or support from psychotherapy? Just basic questions like that, which will allow consumers to make a judgment."

Kelly adds that her organization has initiated a program this year to make educational material and support groups available to MCO carve-outs. "We have patient advocacy spokespersons who can do patient-to-patient training," she says. "So you can say there’s a workshop next Thursday where you can learn some coping skills from other patients who are well and who have been there."

Design educational programs to increase provider awareness and knowledge about depression, enhance screening and diagnosis skills, and increase the use of effective pharmacological and psychosocial interventions.

Educational and training programs should be used to encourage caregivers to take depression seriously as a disease state, argues John P. Docherty, MD, professor and vice chairman, department of psychiatry at Cornell University Medical College and deputy medical director, Westchester division, of New York Hospital. "We have to get past a lot of the bias that exists in our society that says that people with depression should get over it on their own," he says.

Another solution is to allow individuals with the most knowledge of psychological disorders to perform triage, says Glenn Treisman, MD, PhD, associate professor of medicine, associate professor of psychiatry, and director of psychiatric education at Johns Hopkins University in Baltimore. "In general, managed care organizations have the least knowledgeable and least experienced people involved in triage," says Treisman. "What you really want is somebody who’s well trained in psychiatry to decide if there’s a psychiatric disease state present such as depression or if something is a psychotherapy case because someone is demoralized over their chronic medical condition. That kind of distinction often needs somebody who’s really a pro. You can’t make it on the telephone, and you can’t make it if you’re a primary care provider doing 90% glucose management and seeing three cases of depression a year."

Support effective professional collaborations.

"Clearly, in the foreseeable future, medical care will involve people going to primary care providers for most of their care and then being referred to specialists for particular problems," says Hirschfeld. "In order for a complicated illness like depression to be well handled, you have to have communication among primary care, the medical psychiatrist, and non-medical professionals. That’s crucial if the patient’s going to get coordinated, responsible long-term care." Case managers must also play a vital role, especially with depressive patients who also suffer from other chronic conditions, such as diabetes, he adds.

Conduct research to develop new treatments.

"Medication can treat an illness, but other types of therapy and support are needed to treat the person behind the illness and the impact that the illness has had on a person’s life and family," says Kelly. "So things like psychotherapy, diet, and support groups become critically important. There are so many things that patients can do to take control of the illness and not let the illness take control of them."