This project addressed the issue of receiving quality mental health treatment for depression within a primary care setting. Most depressed individuals visit primary care physicians during the course of their episode, but most primary care providers (e.g., nurses, physicians) do not have significant training in mental health diagnosis or treatment. Clinical trials have demonstrated that interventions in which mental health professionals are integrated into primary care settings produce remission rates comparable to those in specialty mental health care efficacy studies. However, most primary care practices do not employ onsite mental health professionals for a variety of reasons. Nevertheless, there is significant potential for improving detection and treatment if quality training is provided to primary care providers. Furthermore, this would help address workforce shortages of mental health professionals - a problem endemic to rural and frontier areas - by improving the clinical skills of a broader range of healthcare professionals, particularly those most likely to be approached for help with depression.
The constituency served for this project included adolescents and adults who were seeking treatment for depression from their primary care provider(s) or those who, in the process of seeking treatment for a physical health problem, were identified as having depression through a screening process.
The four goals of this project were to: 1) Train primary care and mental health providers at nine FQHCs (federally qualified health centers) in the MacArthur program for identifying and treating depression in primary care; 2) Having primary care providers incorporate screening instruments and protocols for scoring and conveying this information to treating physicians within their practices; 3) Patients who screen positive for depression were asked about their symptoms and their desire for education and treatment (i.e., medication, therapy, or both), and then followed a treatment pathway they choose, and 4) Patients who opted for education and treatment of depression (either in primary care or mental health settings) will show clinical improvement over a 6-month period (assuming significant complicating factors-major medical illness, loss of income, etc.- did not arise during the treatment period).
WICHE facilitated the systematic planning and coordination of this project in cooperation with the Division of Mental Health (DMH) and others identified by the Division. This planning and coordination included the development and facilitation of a project steering committee, comprised of members from the Health Care Commission's Sub-Committee on Mental Illness and Depression, the Division of Mental Health, the South Dakota Council for Mental Health Centers and community mental health center representatives, Horizon Health Care Inc. (a FQHC system of nine community based primary care clinics) and WICHE staff.
