A Groundbreaking Call for Universal Depression Screening
By: Paolo del Vecchio, M.S.W., Director, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration
Over one-half of people with mental health conditions do not receive needed treatment. Part of the challenge is identifying who needs help. That is about to change.
The U.S. Preventive Services Task Force (USPSTF), in their latest recommendation statement, issued a landmark call for primary care providers to screen all adults for depression, even if they don’t have any obvious risk factors. This is an exciting development because we know that the family physician’s office is the first place where people go when they experience a mental health disorders. Early intervention through screening and connection to treatment and services may also help head off mental health crises and identify suicide risk. In addition, other high risk populations for depression, such as individuals with challenging chronic medical conditions like cancer or diabetes, will also benefit.
The statement also calls for more careful attention to adults in higher risk groups, including pregnant and post-partum women. Under the Affordable Care Act, USPSTF’s endorsement—based on a careful evaluation of current evidence—means that depression screening is one of several preventive measures that insurance plans must cover with no cost to the consumer.
Universal screening will not happen overnight, and we have challenges to meet. Primary care providers will require training on how to conduct the screening and how to bill insurance for the service. At SAMHSA, we have resources that can help, including Depression in Mothers: More Than the Blues—A Toolkit for Family Service Providers. This toolkit is designed for community-based providers and includes useful information about depression, strategies providers can use daily when helping mothers who may be experiencing depression and their families, and key resources and handouts for mothers with depression.
Along the same lines, the USPSTF recommendation statement addresses concerns related to taking medications for depression while pregnant. It is important for women to have easy access to the information necessary to make informed-decisions along with their physicians, and consider a variety of behavioral health approaches and supportive services in addition to medications.
In addition, the USPTF recommendation calls for additional research to establish evidence-based guidelines for when screening should take place and to validate tools in languages other than English or Spanish. I agree wholeheartedly. In fact, SAMHSA’s collaboration with the Health Resources and Services Administration (HRSA), the SAMHSA-HRSA Center for Integrated Health Solutions, disseminates validated depression screening tools. Validated tools like this should be available online and on mobile platforms so that people can complete them while they wait to see a doctor.
Perhaps most significantly, the guidelines note that screening is likely to be effective only when people who screen positive are appropriately diagnosed and offered evidence-based treatments. That’s why SAMHSA and the behavioral health community must rise to this challenge and make sure that people have access to a range of accessible, affordable, and quality services and treatments of their choosing. This requires continuing efforts to increase service capacity at the community and state levels as well as the provision of patient and family information.
SAMHSA also recommends that providers use shared-decision making and person-centered approaches that promote choice and tailor care to the needs of the individual being served. SAMHSA is expanding its shared decision making tools, including decision aids on anti-psychotic medications, medication assisted treatment, and children’s medications.
I am excited about the USPSTF recommendation statement and its potential to integrate mental health into primary health and help people begin their journeys of recovery, but we have a lot of work ahead to implement universal depression screening and improve treatment capacity. At SAMHSA, we are working to help President Obama achieve his vision of comprehensive mental health care:
It’s not enough to help more Americans seek treatment -– we also have to make sure that the treatment is there when they’re ready to seek it.