Panel calls for prompt action to address human impact of depression in Canada



    CALGARY, Oct. 17 /CNW/ - After two days of hearings at a consensus
development conference on depression in adults, a panel of experts led by the
Hon. Michael Kirby, Chair, Mental Health Commission of Canada is recommending
wide and immediate changes to how depression is viewed, prevented, diagnosed,
and treated in Canada.
    The panel of health professionals, academics, and public representatives
called on federal and provincial governments to develop and promote policies
to significantly impact the systems set up to help those with depression.
    "Governments at all levels need to demonstrate leadership in developing
and promoting policies that will create positive changes in the treatment
system. They need to champion respect for the person with depression in the
home, the workplace, and in the community," the panel concluded. "Depression
must be recognized as the health priority it is and resourced accordingly. An
investment by an informed and caring population is an investment in Canada's
future."

    
    Key panel recommendations include:

    -   Addressing stigma through a public awareness campaign about
        depression in language which will be understood by everyone

    -   Increasing mental health investments in the critical period of
        childhood and adolescence

    -   Developing a comprehensive framework for research in depression
        through a group of partners lead by the Mental Health Commission of
        Canada

    -   Including people with depression regardless of age in the
        decision-making regarding their own care

    -   Encouraging public and private employers to create mentally healthy
        work places and to improve support for employees with depression

    -   Changing the health system so that effective drug and psychotherapy
        are accessible to all people with depression and committing to
        training and funding health care providers
    

    The Consensus Development Conference on Depression in Adults: How to
Improve Prevention, Diagnosis and Treatment was hosted by the Institute of
Health Economics, Alberta Health Services-Alberta Mental Health Board, and the
Mental Health Commission of Canada, with support from the Alberta Depression  
 Initiative.
    For a copy of the panel's recommendations, go to www.ihe.ca and download
consensus statement on depression from the homepage.

    
    BACKGROUNDER

    Panel Recommendations:

       -   Improved anti-discrimination laws, and/or enforcement of such
           laws, may be required to ensure that persons living with mental
           health problems or illness have the same rights as other
           Canadians.

       -   To allow caregivers to write off expenses incurred in supporting
           the depressed person, the Income Tax Act must be amended.

       -   CPP disability and provincial income support programs must also be
           applied equitably so that a disability caused by mental illness is
           treated in the same way as a disability caused by physical
           illness.

       -   Similarly, access to employment insurance, workers' compensation
           and short and long term disability benefits must ensure equitable
           access for persons living with a mental or physical illness.

       -   Public and private employers must be encouraged to create a
           mentally healthy work place and to improve support for employees
           with depression.

       -   Interventions for depression should be tailored for and made
           available to identified high risk groups (e.g. chronically ill
           people, trauma/abuse victims, those suffering from substance abuse
           disorders, families with a positive history for depression,
           post partum mothers, and the elderly).

       -   Childhood and adolescence are critical periods with respect to
           depression. This age group must become a priority in mental
           health.

       -   A population health approach to prevention, early identification
           and intervention should be implemented in schools.

       -   The healthy management of stress and anxiety should be a
           particular focus for prevention efforts at home, school and in the
           workplace.

       -   Individuals presenting for assessment of depression by health care
           providers should be asked about the presence or absence of trauma
           and adverse childhood experiences.

       -   A better understanding by service providers of the relationship
           between substance use disorders, chronic diseases and depression
           is essential for the optimal prevention, early detection and
           effective intervention of these disorders.

    -   Universal screening of Canadians for depression is not recommended.
        Targeted screening of at-risk and marginalized groups is recommended.

    -   The use of assessment tools to support a stepped care approach for
        depression is recommended for the family physician.

    -   The College of Family Physicians of Canada, the Canadian Psychiatric
        Association, the Canadian Psychological Association and people with
        direct experience with depression should develop a toolkit of
        recommended screening and assessment tools appropriate for Canadian
        settings.

    -   Investigate and evaluate service innovations that could help to fill
        the gaps in mental health service delivery (e.g. telehealth,
        internet-based therapy, telephone therapy, family-practice located
        shared therapy, stepped care models, chronic disease management
        models, and alternative reimbursement models).

    -   Treatment studies should be independently evaluated for long-term
        efficacy.

    -   We need studies that will help us understand how to match patients
        with optimal treatment. Effectiveness trials of antidepressant
        medications, psychotherapy and combinations of them are required.

    -   Health system modifications are required so that effective supported
        self management, psychotherapy and pharmacotherapy are accessible to
        all people with depression. This includes commitment to training and
        funding practitioners.

    -   The effectiveness and safety of treatment approaches such as self
        management, lifestyle management and therapies that involve brain
        stimulation need to be subject to rigorous evaluation.

    -   The Mental Health Commission of Canada should facilitate discussions
        about how to best incorporate traditional healing methods and
        spiritual practices from various cultures into routine treatment of
        depression.
        -   The Mental Health Commission of Canada should:
            -   Ensure that its knowledge exchange center has a focus on
                mental health literacy to meet the specific needs of people
                with depression

            -   Develop a program that addresses the stigma associated with
                depression in our society.

        -   A substantial reorganization of the delivery of services for the
            management of depression is required. The assessment and
            treatment of depression must be integrated into Chronic Disease
            Management and Primary Care Reform initiatives. This is
            compatible with the patient-centered model developed by the
            Canadian Collaborative Mental Health Initiative. Health care and
            professional funding rules must be redesigned to encourage and
            support system change and innovation with respect to screening
            and a stepped care approach, within a Chronic Disease Management
            model.

        -   Ongoing funding to facilitate the engagement of people with
            depression, their families and representative groups in the
            delivery of self-help and peer support groups and system reform
            is needed.

        -   Involving employers and insurers as partners to build additional
            supports and services to meet the needs of people with depression
            in the workplace is required.

        -   Methods need to be found to provide services and support to First
            Nations, Métis, Inuit and rural and remote communities. Targeted
            innovation is required in this area.
    

    A group of partners led by the Mental Health Commission of Canada should
develop a comprehensive framework for research in depression considering
issues raised at the Consensus Development Conference on Depression in Adults.
    Other recommendations have relevance for future research. These
recommendations refer to such things as: service delivery models, the role of
primary care, better aligned funding methods to support more effective service
delivery, identifying risks in critical periods during a person's lifetime,
and the cumulative effects of stress.
    The comprehensive research framework should include but not be limited to
the following themes:

    
    -   Biomedical Studies of Depression

        Research on depression should capitalize on the advances in the
        neurosciences.
           -   Multi-disciplinary research teams investigating symptoms,
               co-morbidities, neurochemistry, genetics or imaging that have
               relevance to treatment.
           -   Pharmacotherapy research to develop more effective
               antidepressants. Current drugs have slow response, numerous
               side effects, but are safer, although more costly than older
               medications.

    -   Prevention of Depression

        Adequate prevention is dependent on the identification of risk
        factors. A surveillance system to monitor risk factors for depression
        is needed to evaluate the effectiveness of prevention programs that
        may reduce depression including:
           -   prenatal programs, strategies to reduce childhood abuse and
               its impact, screening for postpartum depression.
           -   Organizational risk factors in workplaces and the programs to
               produce healthy workplaces.

    -   Economics of Depression

        Because resources are scarce and the need is great we must use our
        limited resources most effectively and efficiently. Therefore,
        continued investigation of the costs of depression is required
        including the human, workplace, social, and health systems costs.

        The research agenda in this area might include:

           -   Economic evaluation of different interventions and approaches.
           -   Continued monitoring of health care expenditures to match the
               burden of depression.
           -   Examination of financing and reimbursement structures for
               various models of care for depression that promote access and
               quality in a patient centered environment.
           -   Examination of benefit structures to promote efficient use of
               services and recovery by patients.
           -   Examination of the optimal balance of private (e.g. workers,
               citizens, patients, and employers) and public funding of
               increased access to psychotherapy according to the models
               developed in Australia and the United Kingdom.

    -   Effectiveness of Services for Depression

        Models of care for depression need to dovetail with primary care
        reforms. A possible research agenda might include:
           -   Evaluation of new patient centered treatment pathways for
               depression integrated with other common mental disorders (e.g.
               anxiety disorders and substance use disorders) and common
               chronic diseases.
           -   Development of minimum guideline treatment using simple
               protocols and standardized rating scales.
           -   Evaluation of psychotherapies (including brief and group
               psychotherapy) and self directed treatments (e.g. web CBT).
           -   Evaluation of consumer mutual aid/self-help/peer support.

    -   Epidemiology of Depression

        Emphasize longitudinal studies to examine:
           -   the effects of critical developmental periods,
           -   the effect of cumulative experiences of developmental stresses
           -   'chains of adversity' and 'chains of risk'.

        Ensure the inclusion of depression relevant variables in emerging or
        proposed longitudinal studies in Canada.

        Diagnostic assumptions regarding depression and its sub
        classifications need to be re-examined:
           -   Investigate the use of a dimensional approach to diagnosis.
           -   Boundaries between disorders are less clear than current
               diagnostic systems imply (e.g. anxiety and depression).

    -   Consumers/Patients and Families/Caregivers

        More support should be given to patient driven research. Their lived
        experiences are a valuable guide to the realities of mental illness.

    -   Evidence

        Mental health research needs to broaden its perspective on evidence
        beyond the randomized controlled trial. Qualitative methodology,
        narrative accounts, and others all need to be considered.

    -   Knowledge Exchange

        Any research agenda must invest in knowledge exchange activities and
        evaluate the outcomes and optimal approaches.
    




For further information:

For further information: For interviews, please contact: Rhonda
Lothammer, Institute of Health Economics, Cell: (780) 935-0382,
rlothammer@ihe.ca

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