In the past, acute care and mental health care have been siloed. It's only recently that healthcare systems have come to the conclusion the two have more in common than was previously thought. The mind and the body are not separate entities, where health outcomes are concerned.
Now, with the advent of extreme pressure to streamline care across the continuum, it's clear that a focus on mental health care has great potential to improve acute-care outcomes. Mental health issues are part of a broader spectrum of health concerns that can make medical treatments, including those under the umbrella of acute care, less effective. Patients with undiagnosed or untreated mental health issues are more likely to neglect their care, end up in the wrong care stream, require a hospital readmission or simply avoid the hospital all together.
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From an epidemiological perspective, depression is arguably the most significant mental health issue. A substantial proportion of the global disease burden is due to depression; it has a greater impact worldwide on human health than any other medical condition and is the leading cause of disability worldwide. In the
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Cedars-Sinai nurses are the frontline representation of the initiative. They use the two-question Patient Health Questionnaire-2 to ascertain whether the patient has felt depressed in the past two weeks. If a patient screens positive, he or she takes the PHQ-9, which further explores the potential risks and may trigger an alert for the patient's physician and social worker, if the patient is at a high enough risk for depression.
Through the screen, Cedars-Sinai hopes to improve targeted treatments for individuals, helping them improve from other illnesses without having to battle underlying depression in tandem. "In patients with medical problems, if their depression goes untreated, they have worse outcomes," says Dr. Danovitch. "This initiative recognizes that depression is incredibly common in medical populations. It improves our ability to proactively identify patients with depression. When we recognize them, we can educate them, and offer appropriate treatments or referrals."
One challenge: Identifying a patient with clinical depression doesn't guarantee he or she will get treatment. While nurses and physicians can recommend treatments and refer patients to specialists, there are many barriers to care, such as stigma, adequate insurance coverage, and accessibility of specialty care.
As a first step, Cedars-Sinai is establishing system-wide awareness, and developing partnerships with providers who can provide high quality mental health care. Dr. Danovitch describes the initiative's current goal as an information blitz. Stakeholders are presenting the initiative at committee meetings, putting it on screen savers, making an educational push and getting the word out to as many people as possible.
While it's still early in the process, Dr. Danovitch says there has been plenty of support: "The important thing is that across the board our health care providers have been receptive to the initiative, which is allowing us to provide more holistic health care."
The initiative is an integral part of Cedars-Sinai's response to healthcare reform, according to Dr. Danovitch: "One of the things healthcare reform has taught us to recognize is that if we want to improve health outcomes, we have to focus on addressing underlying behavioral health issues. It is imperative we make efforts to identify mental health and substance abuse problems," he says.
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