Mental Health Charities Welcome New GP Incentives For Depression But Highlight Inadequate Emphasis On Long-Term Management, UK

Two leading national mental health charities, Depression Alliance and SANE, have come together during National Depression Week to welcome the inclusion of depression indicators for the first time in the national Quality and Outcomes Framework ("QOF") of the GMS (General Medical Services) contract. However, whilst marking an important step forward that could improve treatment for many people with risk factors for depression, there is a clear need to broaden these indicators if they are going to ensure appropriate and effective long-term management for one of the most common and debilitating medical conditions in Britain today.



"Although we welcome recognition of depression in the new QOF, it really is just tackling the tip of the iceberg," said Alison Lawrence, Chair of the Depression Alliance Executive Committee. "The QOF, in its current form, focuses solely on the diagnosis of the disease and the screening of people with two comorbidities, those with diabetes and coronary heart disease. It does not address the bigger picture, such as the key issue of providing ongoing management and treating those who experience a recurrence of symptoms. In conjunction with SANE, we therefore intend to reach out to our membership - expert patients and others directly affected by this disease - to ask them what indicators they believe should be included in the QOF, that will tangibly improve their quality of life." This initiative has been developed in partnership with Lilly and Boehringer Ingelheim.



More than two million people in the UK are diagnosed as having depression at any one time, with the World Health Organization predicting that it will be second only to heart disease as the biggest global health burden by 2020.1,2 It is also responsible for 70% of recorded suicides in the UK.3



"In essence, we would like depression to be given a higher priority by the health services," said Marjorie Wallace, Chief Executive of SANE. "We need additional incentives for GPs to identify the possible symptoms of depression and offer prompt treatment and informed choices. GPs need therefore to consider a wider group of patients than those being screened at present, to ensure that all who may be at risk receive help."



Symptoms of depression that are often missed on initial presentation include psychological symptoms such as irritability and lack of confidence; and physical or somatic symptoms such as sleep disturbance, fatigue, and aches and pains that appear to have no physical cause. A recent report by Depression Alliance which was sponsored by Lilly and Boehringer Ingelheim highlighted how 85% of patients believe that their quality of life would be improved if their aches and pains could be effectively managed.4
















"People with depression often face a long road to recovery. This journey frequently requires a long-term therapy, whether cognitive, complementary or pharmacologic. Best practice management should therefore ensure that, on initial diagnosis, patients are registered to enable effective follow-up care and long-term management of their disease." said Ms. Lawrence. "This will not only help the person affected by depression, but ultimately result in a better use of the available healthcare resources."



"There are a range of medications and 'talking therapies' which can be effective and prevent relapse, in both the short and long term. It is only by sustained contact and sensitive response in crisis that relapse can be prevented and quality of life improved," added Ms. Wallace.



The results of the patient research to be undertaken by Depression Alliance and SANE are expected to be available by autumn 2006, and will be presented for review to NHS Employers and the General Practitioners' Committee of the BMA, which negotiate the contract.



--- The new indicators for depression within the QOF are:

- The percentage of patients on the diabetes register and/or the CHD (coronary heart disease) register for whom case finding for depression has been undertaken on one occasion during the previous 15 months using two standard screening questions. (8 points)

- In those patients with a new diagnosis of depression, recorded between the preceding April 1 to March 31, the percentage of patients who have had an assessment of severity at the outset of treatment using an assessment tool validated for use in primary care. (25 points)



--- The QOF measures and financially rewards GP practices for delivering a wide range of services. GP practices score points according to their levels of achievement against these indicators, and from this payments to their practices are calculated.



--- GPs are independent contractors to the NHS and their remuneration is determined through a nationally negotiated contract, the GMS (General Medical Services) contract, of which the Quality and Outcomes Framework forms part. The GMS contract is a local contract between the primary care trust and GMS contractor (GP practice), and is subject to a standard set of national rules and procedures.



--- Pulling Together: Body & Mind Depression Symptoms Survey Report 2005 was sponsored by Lilly and Boehringer Ingelheim, and comprised of two surveys conducted in November 2004 by the Depression Alliance and TNS Healthcare to gain a better understanding of how depression is managed, specifically through assessing whether patients and clinicians are aware of the full range of potential symptoms of depression. Some people associate depression primarily with psychological symptoms such as low mood and lack of pleasure, whereas it can also cause a variety of physical or somatic symptoms such as sleep disturbance, aches and pains, and sexual dysfunction.



--- National Depression Week is a time when organisations and charities join together to focus public, political and media attention on depression. The theme for Depression Week 2006 is complementary therapies. depressionalliance/docs/news/press_releases.html



--- SANE has three objectives:

- To raise awareness and respect for people with mental illness and their families, improve education and training, and secure better services;

- To undertake research into the causes of serious mental illness through The Prince of Wales International Centre for SANE Research;

- To provide information and emotional support to those experiencing mental health problems, their families and carers through SANELINE.



--- Staffed by trained volunteers, SANELINE is open every day of the year, making it the only national helpline for all mental health problems open during evenings, weekends and all holidays. SANE's Caller Care service provides support to callers at times of crisis or further need. In 2005, 37% of those with mental health problems who called SANELINE were suffering from depression. The SANELINE number is 0845 767 8000. sane.uk



--- Depression Alliance is the leading UK charity for people with depression, working to relieve and to prevent this treatable condition by providing information, support and understanding to those who are affected by it.
depressionalliance



--- This initiative has been developed in partnership with Lilly and Boehringer Ingelheim, who have also provided appropriate resources.


References


1. World Health Organisation (WHO)
who.int/mental_health/management/depression/definition/en/.

2. Ohayon MM , Priest RG, Guilleminault C et al. (1999) The prevalence of depressive disorders in the UK. Biol Psychiatry: 45:300-307.

3. Faulkner, A. (1997) Suicide and deliberate self-harm. Mental Health Foundation, Briefing Paper No.1.

4. Pulling Together: Body & Mind Depression Symptoms Survey Report (2005). Depression Alliance.