The Depression Initiative, a five-year long programme aimed at improving treatment for depression has greatly improved the national approach to tackling depression.
The difference between mild and serious depression and the importance of this distinction has become much clearer. People who seek treatment for depression from their GP are now more likely to receive adequate treatment, and medication is less often prescribed.
The Depression Initiative was launched in 2006 under the leadership of the Trimbos Institute and was financed by the Health Insurers' Innovation Fund. Participants included many specialised mental health organisations (GGz), general practices, general hospitals, municipalities, company doctors and universities. Close collaboration also took place with the European Alliance against Depression (EAAD). Within the context of the Depression Initiative, health care professionals are trained to recognise and treat depression in keeping with the Multi-disciplinary Guideline on Depression and the NHG depression standard.
Collaborative care
The last phase of the Depression Initiative targeted the treatment of moderate to serious depression in primary care, the workplace and in hospitals, via the collaborative care model. According to this model, a care manager (nurse) works in close collaboration with a GP, company doctor or specialist and a consultant psychiatrist. The patient is monitored systematically at six-weekly intervals. If there is no improvement, the health professional receives dedicated advice about the next steps to be taken.
If the treatment shows inadequate results after three periods of six weeks, the patient is referred to specialised mental health care (GGz). This takes places with the use of a web-based decision aid. Treatment consisted of a combination of Problem Solving therapy and possibly anti-depressants. This method of treatment was found to be between five and seven times more effective than usual primary care treatment for depression.
In workplace settings, patients treated for depression leading to absenteeism felt better nearly three months earlier than those receiving care as usual.
In hospital settings, patients with chronic illnesses who also suffered from depression showed faster recovery from depression compared to usual care. Moreover, they suffered fewer complications.
The conclusion is that further implementation of collaborative care in the Netherlands is recommended, as is the setting up of a web-based decision aid in primary care in order to provide support to health professionals.
More information: Marjan Heuving
