COMBATING DEPRESSION
Major Depression is a serious and chronic mental disorder that affects well over 20 million Americans, adults, seniors and children, each year, without regard for race, ethnicity, or socioeconomic status. Depression is not only common, it is under diagnosed and under treated, the result being great personal suffering, family and economic burden, tragically death from both suicide and medical illness.
We know that a person who is depressed is more likely than others to engage in behaviors that contribute to poor health such as smoking, not exercising and poor nutrition. Depression can also contribute to the onset of chronic diseases like diabetes, heart disease and asthma, and these diseases have been found to worsen depression. Untreated depression causes distress, disability, and most tragically can be fatal.
The good news is depression can be reliably detected and treatable, with remarkably high rates of response when properly treated (75-80%).
The New York City Department of Health and Mental Hygiene (DOHMH) has adopted a determined ten-point public health strategy called Take Care New York (TCNY). TCNY prioritizes the actions that individuals, health care providers, and New York City as a whole, can take to improve its health and mental health. The10 key areas of TCNY focus on the disorders that cause significant disability and death but which are amenable to interventions. No other city has attempted such an effort. As part of this comprehensive public health initiative, the Division of Mental Hygiene is charged with TCNY item # 5: Get Help for Depression.
Three quarters of a million New York City adults reported experiencing frequent mental distress last year, according to new data from the New York City Department of Health and Mental Hygiene (DOHMH). Nearly 1 in 7 adults (13%) living in the five boroughs reported frequent mental distress in 2005, compared with approximately 1 in 10 adults in New York State and the nation. Many of these people are suffering from depression. Additionally, an in-depth study of data from 2003* found that overall mental health was worse among women, Hispanics, individuals who were formerly married, and among New Yorkers who were poor, in poor health, or chronically unemployed. Only 4 in 10 New Yorkers with poor overall mental health reported receiving counseling or medication for a mental health problem in the past year.
In the U.S., primary care physicians (PCPs) are typically the first line of defense and the major source of ongoing care for most health problems, including depression. People are more likely to go to their family doctor than to a mental health professional. About half of the care for mental disorders is delivered in general medical settings and depression is one of the most commonly seen conditions in primary care. However, PCPs fail to diagnose depression in about half of their depressed patients and when they do, treatment infrequently follows care guidelines that are known to work. This is not because they are bad doctors, or are not trying. It is because standard medical practice does not support what needs to be done.
Combating this debilitating condition requires effort on multiple fronts as social, clinical, and systems barriers to depression treatment still prevail in our society. To overcome the multiple barriers to receiving effective depression treatment, the NYC Department of Health and Mental Hygiene has initiated a systems improvement approach, which we call the Multi-Systems Depression Initiative (MDI). MDI is a multi-pronged strategy to improve depression care by focusing on: providers, clinical practice settings, patients, health plans, public and private purchasers of healthcare, and communities throughout NYC.
The NYC DOHMH MDI has been involved in the following activities and projects:
- Implementing the use of a simple and reliable test for depression in primary care (the PHQ-9, a patient self report of 9 questions) followed by evidence-based management techniques for depression. We are doing so in primary care practices in the City’s municipal hospitals (HHC facilities throughout the City) as well as in other general hospital, primary and specialty care practice settings. We are also doing so in community clinics (Federally Qualified Health Centers) and university student health centers.
- Providing medical educational materials and training on screening with the PHQ-9 and on depression management to PCP and mental health clinic staff.
- In collaboration with the Mental Health Association of New York City and the City Department for the Aging (DFTA), launching a depression screening and management project in a group of Bronx senior centers. In this coming year, we will spread this project to other boroughs and communities, again in conjunction with DFTA.
- Training 25 multi-cultural, multi-lingual social workers through a Division of Mental Hygiene-sponsored scholarship program at the Hunter College School of Social Work.
- Collaborating with the NYC DOHMH Nurse Family Partnership program to incorporate depression screening into its home visiting program for first-time mothers in high-risk neighborhoods.
- Issuing an updated “Detecting and Treating Depression in Adults” City Health Information (CHI), a publication that is sent to over 50,000 NYC health care providers and summarizes best practices for depression screening and depression in adults.
- Issued an updated Health Bulletin for the public to provide education about the symptoms of depression, depression screening and the availability of treatment. This was distributed to over 100,000 people.
- Recently completed a successful Depression Public Mental Health Detailing Campaign to educate primary care physicians in New York City’s highest health risk neighborhoods (South Bronx, North Central Brooklyn and Harlem) and at HHC hospitals and diagnostic centers, which was very well received with over 1,300 contacts, 1,500 detailing kits and almost 20,000 Health Bulletins distributed. Plans are underway to extend this detailing campaign to other boroughs and communities.
- Launched a Public Awareness Outdoor Media Campaign in May, 2006. The campaign tag line is: “Have you asked your doctor for a simple test for Depression?” and has been displayed in ads on subways, buses and check cashing sites. Plans are underway to extend the outdoor media campaign to other boroughs and communities and to do radio and newspaper ads.
- Continuing to support legislation for parity of mental health benefits (where Senator Krueger is a leader in the NYDS Senate), regulatory changes to eliminate Medicaid limitations on mental health services, and seeking to improve insurance coverage for depression screening and management in primary care.
- With support from a policy institute in DC, we have produced a depression policy paper: Changing the Landscape: Depression Screening and Management in Primary Care and have hired 2 Care Managers for the DOHMH Care Management Office to provide telephonic support and ongoing monitoring of people diagnosed as depressed by their primary care doctors.
When depression is not diagnosed and not effectively treated, it is a bad disease. With good care, lives, families and communities benefit. That is our goal.
Lloyd I. Sederer, MD
Executive Deputy Commissioner for Mental Hygiene Services
NYC DOHMH
Jorge R. Petit, MD
Associate Commissioner for Program Services
NYC DOHMH
DOWNLOAD: "Detecting and Treating Depression in Adults"(PDF)
If you are unable to download PDF documents you may contact either Susan Chamlin or Travis Proulx at 212-490-9535. They will immediately mail you a hard-copy.
OTHER RESOURCES:
New York National Association for Mental Health
NYC Department of Health and Mental Hygiene
If you or someone you know needs help with depression, talk to your doctor or call 1-800-LifeNet (1-800-543-3638).