Make Depression Care a National Priority: Depression's Huge Economic Burden Warrants an Equally Large Response

Article excerpt

Depression is one of the most frequently occurring mental disorders, affecting between 7 and 9% of men as well as between 10 and 12% of women. Depression costs more than $80 billion per year in direct care and lost productivity in the United States alone. The World Health Organization predicts that depression will be the number-one cause of disability in the world by 2020.

Untreated depression can lead to serious consequences, including suicide. Less well known, perhaps, is that depression co-occurs with a broad range of persistent health conditions, such as asthma, diabetes, heart disease, and substance use. For each of these conditions, the percentage of people with co-occurring depression ranges from 35% to more than 70%.

Depression not only impairs personal productivity and reduces the global competitiveness of American corporations, but it also harms family and community life. Depression can be difficult to treat effectively, especially because the care system is not well organized. Thus, concern about depression extends from corporate boardrooms to local community health and mental health centers.

A consensus has begun to emerge that closely coordinated mental health, substance use, and primary care is an effective and cost-efficient way to treat depression. As you probably know, last year the Institute of Medicine issued a major report calling for such coordination across all mental health and substance use conditions. Next year, the American College of Mental Health Administration will focus its annual Santa Fe Summit on behavioral healthcare-primary care integration.

To tackle depression, we need to take the following steps, among others:

Create an independent national policy board. This board is likely to be in operation next year, funded jointly by the federal government and key foundations. The board's goal will be to remove impediments to and to promote good, coordinated care. The board's key activities will need to include developing an agenda to remove:

* financial impediments (e.g., the inability to receive payment from Medicaid for a primary care visit and a specialty encounter on the same day);

* systemic impediments (e.g., regulations that prevent the sharing of medical records between primary care and specialty providers); and

* care delivery impediments (e.g., lack of cross-training to promote coordinated care between primary care and specialty staff).

Similarly, the board will need to foster:

* community depression collaboratives (such as those in Atlanta, Kansas City, and Portland, Oregon);

* a new coordination relationship between healthcare and behavioral healthcare plans (e.g., integrated services, such as those offered through Inter-mountain Healthcare in Utah); and

* early screening and intervention (e.g., using instruments such as the Physician Health Questionnaire [PHQ]).

Test demonstrations of different treatment models. Three coordination models seem to be emerging to treat depression:

* Integration. …