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
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
- 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
For a copy of the panel's recommendations, go to www.ihe.ca and download
consensus statement on depression from the homepage.
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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.
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,