York study tests enhanced care for depression patients

Researchers at the University of York are investigating a new method of organising care for some of the three million adults in the UK who suffer from clinical depression.

The innovative regime known as ’collaborative care’ has been developed over the last decade, principally in the USA, but it has never been used in the UK. It involves a case manager, supervised by experts in mental health, working alongside the general practitioner, to improve the management of patients’ symptoms.

Professor David Richards, of the University’s Department of Health Sciences, is leading the 21-month research project, which has secured a £170,000 grant from the Medical Research Council. The study, which involves academics based at the Universities of Leeds and Manchester as well as at York, will provide a test bed for enhanced care of depression.

The supply of psychological therapy for depression sufferers in the UK is patchy while about half the people prescribed antidepressant medication abandon it within a week, often due to adverse initial side-effects.

Professor Richards said: “There is a substantial body of evidence to suggest that this collaborative approach improves depression care but all that evidence has been gathered outside the UK, mainly in the USA. In consultation with organisations in the field and patients, our research will develop a UK-appropriate protocol that is faithful to the original models, while taking account of our different health system.”

A small randomised control trial will then aim to discover what sort of health professional would best fill the role of case manager. Initially, they will be nurses, counsellors or graduate primary care mental health workers, who have been introduced into the NHS in the last two years.

The trial will establish the pattern and nature of contact between case manager and patient. Case managers will use the telephone as the principal means of contact, though only after an initial face-to-face meeting.

Professor Richards added: “Case managers will help patients to manage their medication and give low-intensity psychological help. Treatment will be much more structured than counselling. Telephone contact will allow case managers to deal with more patients as well as being less burdensome for patients. Each telephone consultation is likely to last 15 minutes or so.

“At any one time, between six and eight per cent of people in this country are suffering from depression. The World Health Organisation will very soon declare that the economic burden of depression worldwide will be second only to that of coronary heart disease.

“This study will helpus to determine whether collaborative care can provide a more effective and efficient approach to the treatment of this distressing illness.”