From The Menninger Clinic, Houston, TX.
- Objective: To summarize the Perfect Depression Care initiative and describe recent work to spread this quality improvement initiative.
- Methods: We summarize the background and methodology of the Perfect Depression Care initiative within the specialty behavioral health care setting and then describe the application of this methodology to 2 examples of spreading Perfect Depression Care to general medical settings: primary care and general hospitals.
- Results: In the primary care setting, Perfect Depression Care spread successfully in association with the development and implementation of a practice guideline for managing the potentially suicidal patient. In the general hospital setting, Perfect Depression Care is spreading successfully in association with the development and implementation of a simple and efficient tool to screen not for suicide risk specifically, but for common psychiatric conditions associated with increased risk of suicide.
- Conclusion: Both examples of spreading Perfect Depression Care to general medical settings illustrate the social traction of “zero suicides,” the audacious and transformative goal of the Perfect Depression Care Initiative.
Each year depression affects roughly 10% of adults in the United States . The leading cause of disability in developed countries, depression results in substantial medical care expenditures, lost productivity, and absenteeism . It is a chronic condition, and one that is associated with tremendous comorbidity from multiple chronic general medical conditions, including congestive heart failure, coronary artery disease, and diabetes . Moreover, the presence of depression has deleterious effects on the outcomes of those comorbid conditions . Untreated or poorly treated, depression can be deadly—each year as many as 10% of patients with major depression die from suicide .
In 1999 the Behavioral Health Services (BHS) division of Henry Ford Health System in Detroit, Michigan, set out to eliminate suicide among all patients with depression in our HMO network. This audacious goal was a key lever in a broader aim, which was to build a system of perfect depression care. We aimed to achieve breakthrough improvement in quality and safety by completely redesigning the delivery of depression care using the 6 aims and 10 new rules set forth in the Institute of Medicine’s (IOM) report Crossing the Quality Chasm . To communicate our bold vision, we called the initiative Perfect Depression Care. Today, we can report a dramatic and sustained reduction in suicide that is unprecedented in the clinical and quality improvement literature .
In the Chasm report, the IOM cast a spotlight on behavioral health care, placing depression and anxiety disorders on the short list of priority conditions for immediate national attention and improvement. Importantly, the IOM called for a focus on not only behavioral health care benefits and coverage, but access and quality of care for all persons with depression. Finding inspiration from our success in the specialty behavioral health care setting, we decided to answer the IOM’s call. We set out to build a system of depression care that is not confined to the specialty behavioral health care setting, a system that delivers perfect care to every patient with depression, regardless of general medical comorbidity or care setting. We called this work Perfect Depression Care Spread.