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The Depression Care Manager and Mental Health Specialist as Collaborators Within Primary Care

Received May 13, 2003; revised June 22, June 27, 2003; accepted June 27, 2003. From the Departments of Psychiatry and of Community and Family Medicine at Dartmouth Medical School (TEO,AJD) and the Intervention Research Center for Late-Life Mood Disorders, Department of Psychiatry, Weill Medical College of Cornell University (HCS). Send correspondence to Dr. T.E. Oxman, Department of Psychiatry, Dartmouth Medical School, One Medical Center Drive, Lebanon, NH 03756. e-mail: thomas.oxman{at}dartmouth.edu

Objective: The authors reviewed the implications of the latest generation of health services research studies on primary care practice system changes for depression management, especially in the roles of care managers and mental health specialists. Methods: Authors conducted a review of four large, related, multisite trials testing system changes in the delivery of care to depressed, mostly older, primary care patients. Results: These studies confirm that older patients are more likely to accept collaborative mental health treatment within primary care than within mental health specialty care. The study results published to date suggest that these system changes produce better outcomes than usual care for depression in a wide range of patients and healthcare organizations. Two key partners in implementing these system changes are a care manager to assist the primary care physician in patient education, treatment, and treatment monitoring, and a mental health specialist to provide care-manager consultation and collaborative care with the primary care physician for more complex cases. Conclusions: Most patients with depression first seek attention for their symptoms in primary care, rather than in the mental health specialty sector. Since primary care visits are necessarily brief and pressured by competing demands to manage other medical problems, practice system changes are necessary. For mental health specialists, these studies emphasize the importance of joining and being integrated into primary care. Consultative and supervisory roles allow the specialist to indirectly but effectively serve a larger number of patients.

Key Words: Depression • Health Services Delivery • Primary Care

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