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Depression: Implications for State and Local Healthcare Programs

Public & Private Initiatives


Lt. Col. Kathryn Dolter, Ph.D., Quality Management, U.S. Army Medical Command

Eric Gopelrud, Ph.D., Director, Office of Managed Care, Substance Abuse and Mental Health Services Administration (SAMHSA)

Rear Adm. Carolyn Mazzella, R.N., M.S., M.P.A., Chief Nurse Officer, Health Resources and Services Administration (HRSA)

Charlotte Mullican, M.P.H., Health Scientist Administrator, Agency for Healthcare Research and Quality (AHRQ)

Harold Pincus, RAND Corporation

Frank Sullivan, Ph.D., Senior Advisor, Health Care Financing Administration (HCFA)

Public and private sector organizations have resources that are available to assist State and local government agencies in their efforts to design, implement, and evaluate programs and policies to more effectively treat depression.

Lt. Col. Dolter explained that the Departments of Defense (DoD) and Veterans Affairs (VA) have done a great deal to address the issue of depression within the U.S. armed services. The DoD has developed several initiatives, including the DoD/VA Clinical Practice Guideline Effort and the DoD/VA Depression Guideline Tool Kit. The guidelines are supposed to be used as tools to:

  • Improve research utilization.
  • Assure appropriate amounts of care and improve resource utilization.
  • Prevent errors and ensure accountability.
  • Guide learning, stimulate research, and decrease variation in care.

In order to develop effective tools, several challenges must be faced:

  • Personnel costs are high for initial guideline and tool development.
  • Measurement and feedback are required to make any tool effective.
  • Collection, assessment, and analysis of existing toolkits must be completed.
  • Flexibility and adaptability of materials must be a high priority because they will be used in a wide variety of settings.

Eric Gopelrud discussed SAMHSA's focus on partnerships to develop programs and promote research and services for improving care of depression. SAMHSA gives out discretionary grants each year in a peer review process. SAMHSA is working in collaboration with other Federal agencies, including the National Institute of Mental Health, the Agency for Healthcare Research and Quality, the Department of Defense, the Health Care Financing Administration, and others to develop programs for mental health and to focus on issues of common interest and common importance.

Rear Adm. Mazella described HRSA's programs, which include: grant monies, services, and support provided by the Bureau of Primary Health Care, Bureau of Health Professions, Maternal and Child Health Bureau, and Bureau of HIV/AIDS. In addition, Rear Adm. Mazella discussed other Federal initiatives that have been undertaken recently to raise the level of awareness about depression and depressive issues in healthcare. In 1999 the Surgeon General completed a report on mental health that has received a great deal of attention. This report called for:

  • Improving public awareness of effective treatments.
  • Overcoming the stigma of mental illness.
  • Ensuring the supply of mental health services and providers.
  • Ensuring state-of-the-art treatments.
  • Reducing financial barriers to treatment.

In addition, in early 2000, the Surgeon General produced A Call to Action to Prevent Suicide, a document that is meant to increase awareness, enhance intervention services, and advance suicide prevention initiatives.

Charlotte Mullican discussed the work that AHRQ is doing in the area of depression and what benefits can be provided to State and local agencies. Outcomes and AHRQ research findings can and have been used quite significantly in the areas of mental health. These findings can assist in the development of:

  • Clinical practice guidelines for States.
  • Tool kits for assessing quality
  • Intervention programs.
  • Specific recommendations and guidelines for research, practice, and policy.
  • Evidence-based practice reports.

AHRQ also provides funding opportunities to support improvements in health outcomes, to strengthen quality measurements and identify strategies to improve access, to foster appropriate use of services, and to reduce unnecessary expenditures.

According to Harold Pinkus, The Robert Wood Johnson Foundation has initiated a new national program on depression to address the clinical care management of depression in primary care. The goal of this program is to get what is known about the treatment of depression into the primary care setting by working at multiple levels:

  • Incentives—planning and implementation grants that link plans and practices with purchaser involvement.
  • Values—a grants program that funds projects that conceptualize and operationalize thinking at a variety of levels, increasing incentives, decreasing disincentives, and assessing value of treatment programs.
  • Leadership—identification of senior leaders in primary care to provide mentoring to junior-level providers.

Frank Sullivan reiterated the importance of collaboration between State and Federal initiatives. He emphasized the work that is being done at the Federal level to develop mechanisms to assist the States in providing more effective, higher quality care for depression. He suggested that States not overlook the potential involvement of HCFA regional offices in program planning, implementation, and evaluation.


U.S. Public Health Service. The Surgeon General's Call To Action To Prevent Suicide. Washington, DC:1999.

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