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Treating Depression as a Health Issue
By Candice Porter, LICSW
Depression is predicted to be the second leading worldwide cause of disability by 2020, after heart disease, according to the World Health Organization (2001). In order to be recognized as the public health issue it is, depression needs to garner the same attention as physical health conditions.

Unlike physical health conditions, mental health still carries a stigma and remains one of the largest barriers to seeking treatment. Every year, approximately 15.2 million adults experience a major depressive episode (MDE). Combined data from the 2008 to 2012 National Surveys on Drug Use and Health show that more than one-third of adults with past year MDE (38.3 percent) did not talk to a health or alternative service professional during the previous 12 months (Substance Abuse and Mental Health Services Administration, 2014).

Social workers play a vital role in advocating for depression as a public health issue, extending their reach into communities both in person and online, and partnering with primary care physicians to reduce stigma and increase patient wellness.

National Depression Screening Day, scheduled this year for Thursday, October 9, provides an opportunity for social workers to bring depression to the forefront of conversation within their communities. In support of the occasion, organizations nationwide will hold health fair style events and offer online screenings to support their communities and connect the public with mental health resources.

Baxter Chandler, LICSW, the director of behavioral health at Holyoke Medical Center, believes holding such events helps combat the stigma associated with mental health. “In a medical center, we promote self-care for asthma and understanding heart health. It’s important to have an event that treats mental health in the same way. It puts a public face on depression and mental health, lets people know it’s okay to talk about and normalize it.”

Last year at the event, Chandler recalls, a woman completed the screening form, but when he reviewed it, something didn’t seem right. He asked her if the form was about her; she replied that she had completed the form on behalf of her husband. She was worried he was depressed and he had not wanted to attend the event himself.

“It gave me the opportunity to coach her on how to talk to her husband about depression and how to help him seek help,” says Chandler. Her husband later called and made an appointment. “The screening events allow us to reach community members that may have never thought to take a screening for mental health before. It also allows someone to take it on behalf of a loved one and find out how to get help, or take it home and see if they should seek treatment,” says Chandler.

Reaching people in their community is an ideal way to reduce stigma surrounding mental health and begin a dialogue about the importance of checking in on one’s mental health the same way they check in on their physical health.

Leveraging Technology
For those who do not want to attend a health fair or seek out treatment for a potential mental health issue, social workers can extend their reach through technology.

“As social workers, we pride ourselves on meeting people where they are,” says Marian Mattison, DSW, associate professor at Providence College. “And today, where people are is online. People go online to meet each other and then determine if they want to continue to connect. As social workers, we should expect that people would want to connect with us in the same way.”

Mattison believes that the social work community, like the medical community, needs to embrace technology and adopt telehealth standards for the profession. “As we educate future social workers, we need to provide them with an awareness and understanding of the technology that is currently available to clients as well as best practices for how to use technology in their work.”

One technology that has been shown to provide an effective path to treatment is online screening for behavioral and mental health. While not diagnostic, the tool allows patients to make informed decisions about their mental health through self-assessments.

An independent University of Connecticut study that examined the impact of online mental health screenings on modifiable behavior revealed that online screening is effective in connecting individuals at risk of depression with treatment resources (Aseltine, 2008).

The study revealed that 55 percent of the 964 participants who took an online screening for depression sought treatment within three months of screening, and almost one-third had never previously been treated for depression. The vast majority of participants were still in treatment three months following the screening, and most of those in treatment reported that their symptoms had improved.

Mary Quinn, LICSW, training coordinator at Samaritans of Merrimack Valley believes online screenings are a “great avenue for someone to access mental health information in the privacy of their own home.” She adds that it can be difficult for someone to start a conversation with a counselor or therapist and the online screening results provide that person with a starting point for a discussion on their mental health.

Working With Primary Care
Those experiencing a mental health disorder may not always know to seek the help of a mental health professional and may elect to see their primary care physician. In fact, nearly 74% of Americans who seek help for depression or symptoms of depression will go to a primary care physician rather than a mental health professional (Cassano, Fava, 2002).

When mental health professionals and primary care physicians work together, they can reduce stigma surrounding mental health, provide holistic care for the patient, and reduce outpatient costs.

Now with the Affordable Care Act, Americans have greater access to mental and substance abuse benefits, making them more likely to see their physician for behavioral or mental health issues. The Affordable Care Act also provides patients with coverage for mental health preventive services, such as depression screening.

The Journal of Clinical Psychiatry suggests that primary care physicians “become accustomed to screening for and treating depression just as they screen for and treat hypertension.” The diagnosis of depression is missed up to 50% of the time in a primary care setting so it is imperative for physicians and mental health professionals to work together (Montano, 1994).

A recent study by the British Medical Journal found that when primary care practices utilized a social worker to help them treat older adults with depression, the patients were 24% less likely to die compared to those in usual care (Gallo, Morales, Bogner, Raue, Zee, Bruce, et al., 2013).

“Depression is a symptom of something that has a physical component to it like any illness does, and then it has a psychosocial component to it like any other illness,” said NASW expert, Anna Scheyett, PhD, MSW, LCSW, dean of the College of Social Work, University of South Carolina. “Whether it’s psychosocial conditions that are causative, or that are comorbid, or that are sequel, social workers can be hugely helpful in partnering with physicians to provide holistic care to the patient.”

As holistic health continues to gain momentum, social workers have the opportunity to bring mental health to the forefront of patient care by reaching patients who may not have previously considered mental health treatment and partnering with physicians to provide complete care.

National Depression Screening Day
Developed in 1991 by Screening for Mental Health, Inc., National Depression Screening Day is held annually during Mental Illness Awareness Week in October. The initiative, comprised of awareness events that include an optional screening component, educates and raises awareness of depression and connects people with support services.

To promote local National Depression Screening Day resources in your area, visit mentalhealthscreening.org or helpyourselfhelpothers.org.

— Candice Porter, LCSW, is executive director of Screening for Mental Health, Inc., a national nonprofit and the pioneer in large-scale mental health screenings for the public.

Aseltine, R. (2008). University of Connecticut. Evaluation of the 2008 National Depression Screening Day Online Screening Program .

Cassano, P., Fava, M. (2002). Depression and public health: an overview. Journal of Psychosomatic Research, 53(4), 849-857.

Gallo, J. J., Morales, K. H., Bogner, H. R., Raue, P. J., Zee, J., Bruce, M. L., et al. (2013). Long term effect of depression care management on mortality in older adults: follow-up of cluster randomized clinical trial in primary care. The British Medical Journal, 346, f2570.

Montano, C. B. (1994). Recognition and treatment of depression in primary care setting. Journal of Clinical Psychiatry, 55 Suppl, 18-34.

Substance Abuse and Mental Health Services Administration. (2014). The NSDUH Report. Retrieved from http://www.samhsa.gov/data/spotlight/spot133-major-depressive-episode-2014.pdf.

World Health Organization. (2001). Mental Health A Call for Action by World Health Ministries. Retrieved from http://www.who.int/mental_health/advocacy/en/Call_for_Action_MoH_Intro.pdf.