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Diagnosing and treating depression
- Chris Manning (12 June 2000)
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Chris Manning, Co- chair PriMHE Hampton Wick
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Dear Sir What do we know about depression? It is a lumpy continuum in terms of presence and severity; it is not something that you do or do not have. It is far more than a mere mood disorder and causes very high levels of morbidity, lost personal life quality and huge socio-economic cost. The Hampshire project also demonstrated that, in terms of both prevalence and outcome, it is causily related to proven socio-economic indicators of deprivation. Patients and the health teams looking after them can therefore be equally hampered and enfeebled by a lack of resources and encouraging environments and attitudes. Many of the primary health care professionals I meet describe a certain pointlessness to the diagnosis and 'treatment'of depression for all the above reasons - knowing that many 'upstream' factors need to be addressed as well as psycho-social therapeutic interventions being offered, assuming they are even available. Indeed, they may be depressed or demoralised themselves to the point where all they seem to think and talk about is retirement or active non-engagement with change. Joined up thinking and working do indeed offer the best alternative yet to the traditional fire-fighting and short-term reactive solutions usually deployed. Primary care organisations can now start to treat whole 'communities' (even help re-create them?)rather than just individuals, provided that the whole process is actively nurtured and does not degenerate into the familiar hectoring and personal agenda-ridden environment that so typifies many of the so-called dialogue opportunities.
Many are so busy or leaderless that they bring much personal mental clutter to such meetings, whilst others ARE helping change happen. The latter should be provided with numerous opportunities to help the former. 'Top-down' now needs to be aligned to a range of long-term 'bubble-up' interventions. For example, primary care action research, undertaken by enthusiastic and positive people adequately and strategically funded with results being shared and distributed effectively via a network of similarly interested people and groups. This could involve all concerned groups, not just primary health care professionals. Peer-to-peer education and training, in multi-disciplinary groups, in protected time and space, should be an enduring priority for the NHS . All future doctors and nurses should be prepared for a 'real world' centered on patient need, rather than the needs of academic or other governing institutions that so often serve to remove our humanity only to replace it with the very language and mind-sets we have to unlearn later when we have to roll up our sleeves together to pull a patient-user out of the mud. People could be re-enthused to develop their own local solutions aligned to national objectives, targets and evidence (preferably not of the SBO- Statement of the Bloody Obvious) - type. This evidence should include the personal experience of both health care professionals and users and also have qualitative character. It was, and is, my depression that convinces me of the need for all this to happen. Working in the often crazy 'traditional' manner deprived me of the oxygen of creativity that so many of us have. I have a hunch that, just as asthma tells those who have it what the air quality is like in a city, so depression may often be telling us a lot about the way we are running our culture at the cerebral level. Yours Faithfully Dr. Chris Manning MRCGP
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