The vision of the Coalition’s Depression in Primary Care Partnership project was to build a community-wide system of care for mental health problems, focused on the primary care setting, with special emphasis on the treatment of
depression. Additionally, the partnership project sought to carry out translational research exploring the effectiveness of the mental health care system in Genesee County via a community-academic partnership between Genesee County stakeholders and partners from the University of Michigan Depression Center.
Specifically, the Depression in Primary Care (DPC) concept calls for an efficient and flexible program to support primary care clinicians’ management of their depressed patients. The program was designed at the University of Michigan Depression Center to follow the Chronic Care Model, and to be expandable to cover other chronic health problems. The Depression in Primary Care model includes the following core elements:
- Care management services (by a supervised MSW) matched to the level of depression severity;
- Ongoing disease monitoring (by a care manager) and clinician feedback at the individual patient level;
- Evidence-based treatment advice (from care manager and psychiatrist) to primary care clinicians;
- Patient education, activation, and self-management assistance;
Clinical information system (CIS) to facilitate disease monitoring and clinical communication.
In May 2006, the model was presented to the Coalition’s Mental Health & Substance Use (MH/SU) Task Force by representatives from the University of Michigan Depression Center. The Task Force felt there was an opportunity to tailor a similar program to the landscape of mental health care services in Genesee County. In September 2006, these partners came together to form the Greater Flint Depression in Primary Care partnership, proposing to address depression in Genesee County by forming a community-academic partnership, building a community-wide system of care for mental health problems (focused on the primary care setting), and carrying out translational research exploring the effectiveness of this system of care in a real-world setting.
In 2007, the project received a two-year infrastructure building grant from the National Institute of Mental Health. Goals of this grant included an analysis of the places in which mental health care services are provided locally, analyzing how clinical data flows between providers and systems, and determining an appropriate set of measureable mental health metrics that could assess the quality of the local mental health care system as a whole.
In the grant period that followed, the project completed many accomplishments relating to planning for how to address the treatment of depression in primary care and mental health services in Genesee County. The accomplishments included:
- Construction of a community stakeholder coalition via the GFHC’s Depression in Primary Care Community Steering Committee;
- Consultation with content-area experts;
- Completion of stakeholder interviews conducted among primary care physicians, psychiatrists, specialty mental health providers, insurers, and patient/consumer advocates;
- Completion of community dialogue sessions and focus groups with more than 50 community members to identify common problems relative to depression treatment in the community;
- Development of a Mental Health Care Services Map;
- Development of a Mental Health Patient Pathway Map;
- Determination of an appropriate set of measurable mental health metrics;
- Developed the framework and business case for a local DPC Pilot Project to be instituted and tested if adequate local funding were secured.
Following the completion of these accomplishments, the partnership developed two intervention designs for possible implementation of the DPC project into the local community. The first design outlined a DPC Pilot Project which would serve approximately 300 patients and carry out research to determine the project’s effectiveness and suitability for scale expansion to a large patient base. The second design, which was to be implemented following the completion of the pilot project, was a depression in primary care community wide intervention which could serve up to 1,800 patients.
The project is currently on hiatus as alternative opportunities for partnership and funding are considered.
