NCQA: Early Intervention, Quality Follow-Up Care to Combat High Cost of Mental Health Care: Page 3 of 3
Fixing a Broken System
Scholle contends that there are tangible steps that can be taken to make improvements across the nation. One is to encourage better communication among providers, adolescents, and their families about depression. This affects a number of adolescents, she said, and this should be discussed because effective treatments do exist.
“The second piece is building on good access to mental health treatment,” she said. This includes medication, talk therapy, and additional forms of treatment so that adolescents and their families can work with their care team to identify the most appropriate treatment.
“Part of that access is to make available for adolescents services beyond medication,” she emphasized. For many adolescents and their families medication may not be the right fit. Oftentimes talk therapy is preferred, but that may not be as readily available.
Coordination and follow-up is essential as well. “When you’re depressed you feel worthless,” Scholle explained. “You often don’t feel like doing anything, so having someone on the care team who is working and reminding you that you can get better is an important step.” Sometimes it’s just having the systems in place to track people and ensure they’re coming back, she added. Organizations really need to implement a systematic approach to successfully handle this aspect.
During the search for organizations to include in the study, Scholle and O’Connor sought out practices that consistently utilize standardized tools to assess depression symptoms and also capture that information in an electronic format. Ultimately, they examined routine care within 3 large health care systems that included 2 sizable HMOs in the western United States and a network of community health centers in the Northeast region.
One aspect that is important to understand about the study’s results, Scholle explained, is that the organizations examined are well-positioned leaders that have essentially taken a leap ahead of many other providers by demonstrating a commitment to use tools and adopt the approach of making behavioral health services available. Because sites that participated in the study are highly regarded institutions, the results potentially overstate the quality of care found in other settings.
It just goes to show how difficult it is to treat adolescent depression even when resources are available. And while this particular study honed in on the treatment of adolescents in particular, the authors believe it also sheds light on the challenges of treating depression at large, regardless of age. The stigma surrounding mental health care is pervasive, O’Connor said. As such, there’s a real opportunity for primary care doctors and other physicians to discuss depression and maybe even provide treatment and support for mental health concerns.
Allowing providers in various roles to have access to best practices, guidelines, training, and support for how to identify mental health concerns like depression using validated tools is important, but so is knowing how to appropriately coordinate care—an issue that certainly extends beyond adolescent depression alone.
“We have taken the results of this study, and NCQA has developed measures that we’ll be using to try to encourage health plans to work with providers on improving the quality of depression care for adolescents and adults,” Scholle said. “That was the [inspiration] for this work was to develop quality measures, and we’re happy to say that we’re going to be using those to encourage health plans to pay attention to this problem and to work with primary care and behavioral health providers—and the adolescents and families who are their members—to try to really improve outcomes.” ■