Improving outcomes in depression

Dear Sir

An overview by experts in the field, reasoning for and recommending,
the better quality and delivery of care to a substantive population,is
greatly to be welcomed.

My own treatment started with a non evidence-based hug from a bear of
a psychiatrist and continued with further non evidence-based home visits
from a CPN, usually two to three times a week, and accompanied by the
consumption of tea and biscuits.

My CPN was "assigned" by the psychiatrist who picked the best fit,
using his intuition, thus presumably sparing further time for work, rather
than being locked in a 3 hour Monday am assignment meeting with 15 other
much needed professionals. I was also spared the rigours of being admitted
to an NHS psychiatric ward where my worst fears about becoming psychotic
or losing my mind could easily have catalysed just that. I have no
theoretical problem with people of all diagnoses being together, but that
was then, and this is now.

The overall feeling from both of these caring people was that they
knew what they were talking about, and in the depths of my despair were
still able to inspire hope. I knew they knew what they were talking about.
That experience convinced me, as much as anything else in my life, that it
was the intervener as much as the intervention that mattered, and that
process was as important as outcome. I think life is really that simple.
Instead of now spending vast amounts on further research, perhaps we could
use it simply to provide the resources that people like myself have, and
do, benefit from, in the context of a whole system approach. The solutions
for mental distress are not just medical either and we must now work
outside of that traditional box.

Early intervention and active management work for every other
condition known to man and prevent the long term complications of
potentially recurrent or chronic ill health, whether it be asthma,
diabetes, hypertension or depression. The cerebral dysfunction associated
with depression (which is far more than a mood disorder) produces lost
life quality, disability, comorbidity and somatisation - all of which cost
the health, social and employer budgets billions of pounds a year, as well
as placing a huge burden of work on the NHS primary care practitioners
(and how refreshing to see the developing role of other health and social
care professionals in this).

The voluntary and private sectors also have a huge part to play, but
integrated solutions should not be at the expense of a lesser involvement
of the statutory sector, simply to enable Govt to keep taxation down or
get off the hook of central responsibility for service provision under the
guise of increasing "the flexibility for local solutions".

Early recognition, better management and treatment adherence
must become the order of the day together with the educational message
that mental health issues in consultations should be dealt with as a
priority at the beginning, not a door-handle exit strategy at the end. In
this respect, the NSF for Mental Health actually underpins all the others
and provides the template for the generic issues that weave through all of
them.

For a start, I would like to suggest that we could explore the use of
SMS text messaging to encourage concordance, questionnaires that enable
patients to set THEIR parameters of concern in terms of symptoms, wished
for outcomes, especially in terms of quality of life, social functioning
and recovery.

The introduction of depression management into the GP chronic disease
management remit and remuneration might also go a long way to improving
standards of care for this group of patients a lot more quickly. When I
see the latter, I will be finally convinced that Govt. is committed to
doing something real, rather than rhetorical, about the care of this now
extremely common, and for many, devastating, if not fatal,condition.

Yours Faithfully

Dr Chris Manning