MHTF Agenda Items
26 April 2005
[Requests]
(1) $5k for student-driven mental health outreach, from new health fee
(2) MHTF membership on hiring/search committees
(3) Past data & trends at CPS (any existing data):
-UHS user survey
-CPS user survey
-Intake form data
[Updates]
(1) Online depression screening implementation (UHS)
(2) Depression on College Campuses Conference (Temina)
(3) Mental Health Committee progress (Nicole, Dan)
(4) SAMHSA Suicide Prevention Grant & MHTF participation (Jeff)
(5) Mental Health Survey Progress (Temina)
[Discussion]
(1) Phone/appt follow ups for off-campus psychiatric/counseling referrals
(2) Questions about satisfaction with off-campus referrals for UHS user survey
(3) Changing how clinicians ask about suicide (using more context?)
[Planning]
(1) MHTF Summer Plans
-Recommendations to the GA
-Fundraising
-SISS new student orientations
-GSI training materials (Linda?)
-Feedback on MH coverage of health insurance
(2) Health Fee Implementation for summertime
(3) CPS Advisory Committee Meetings or Communication (?)
HEALTH | April 13, 2005
Depressed? New York City Screens for People at Risk
The practice is one that health officials hope will become a routine part of primary care, much like a blood pressure test.
By MARC SANTORA and BENEDICT CAREY
Doctors in New York City have begun to use a simple questionnaire to determine if a patient is at risk for depression, a practice that health officials hope will become a routine part of primary care, much like a blood pressure test or cholesterol reading.
The new program is the first to carry out depression screening using a scored test on a wide scale. It comes amid a spirited national debate among psychiatrists, policy makers and patient-advocacy groups on the wisdom of screening for mental disorders, especially in children.
In 2003, an expert panel convened by President Bush recommended expanding mental health screening, and Congress budgeted $20 million in supporting money for state pilot programs for this year. Several states, including populous states like Florida and Illinois, have begun to investigate large-scale screening plans, and scores of schools and other youth centers throughout the country have used instruments to test youngsters for suicide risk.
But some politicians and advocates for patients argue that testing people broadly for mental conditions is an invitation to overdiagnosis, unnecessary treatment and lifelong stigmatization.
In New York, no federal money is being used for the program, which is under way in hospitals run by the city. The test, which is being given to adults only, derives a depression score from the answers to nine questions. It is not meant to yield a formal diagnosis, but a high score would lead a doctor to recommend a more thorough clinical screening.
The test includes questions about mood and behavior.
For instance, patients are asked if over the past two weeks they have felt ''down, depressed or hopeless.'' They can answer by checking one of four categories: not at all, several days, more than half the days or nearly every day. Dr. Lloyd I. Sederer, who heads the mental health division of the Department of Health and Mental Hygiene, which is leading the New York effort, said he hoped the screening would set an example for other doctors in New York and around the country.
''It is our hope to have this become a standard practice,'' Dr. Sederer said.
Health officials in New York City are working with the Health and Hospitals Corporation to put their screening program into effect. So far, only about a dozen primary-care physicians are using the test, which was developed using research from the RAND Corporation. The goal is to have every primary-care physician in the city hospital system using the test within the next two or three years. One in every four New Yorkers uses city hospitals for basic health-care treatment, meaning the program could soon involve millions of patients.
Dr. Sederer said that a similar screening test could be developed for adolescents and that if the testing of adults gained acceptance, it would be easier for doctors to use a screening procedure for patients of any age.
Psychiatrists and other proponents say mental health screening is long overdue. They argue that millions of people with serious mental disorders never get help, and that heightened vigilance would not only allow doctors to head off much worse mental problems later, but would also reduce the tremendous costs of untreated illness.
Surveys have found that about 16 percent of Americans -- or as many as 46 million people -- suffer from depression at some point. And by some estimates, depression costs the nation $44 billion a year in lost work and disability -- more than any other illness, including heart disease.
But opponents say that depression is not always easy for primary-care doctors to recognize, even in people who seek help, and they argue that a screening score of any kind could needlessly confuse or worry patients.
''When you label people as having a mental problem, such a label stays with them for their entire lives, whether or not it's accurate,'' said Vera Hassner Sharav, president of the Alliance for Human Research Protection, a patient-advocacy group that has been campaigning to block screening for mental health.
Critics like Ms. Sharav contend that screening tests will also increase the use of psychiatric drugs, including antidepressants like Zoloft and Prozac, whose use in children and adolescents has recently come under scrutiny by regulators.
Representative Ron Paul, a Texas Republican and a gynecologist, introduced an amendment last fall to block federal financing for screening programs, in part because of worries about overmedicating schoolchildren. The plan was rejected.
''We already have a tremendous number of kids being put on drugs like Ritalin and Prozac,'' Dr. Paul said, ''and I think if these screening programs grow, you're going to see a lot of people pushed into medication programs for behavioral problems.''
Dr. Sederer and psychiatrists, psychologists and administrators around the country who favor screening say these concerns are overblown and obscure a much larger problem: a dismissive public attitude toward mental illness.
Bill Emmet, coordinator for the Campaign for Mental Health Reform, a coalition of organizations working to build support for screening and other mental health programs, said: ''Are people sometimes misdiagnosed? Of course. But the fact is that there are whole segments of the population that for a variety of reasons are not being diagnosed with problems they do have, and that is the far greater problem.''
Dr. Sederer said that once doctors were convinced that a quantitative score worked in recognizing depression, they would be more open to using similar measures for other areas of mental health.
Still, he acknowledged that ''nobody likes to be measured'' and said that there had been some resistance from doctors who worried that this would take away from already limited time with patients and add to their workload. The science behind screening is mixed. In studies of patients who belong to health maintenance organizations in California and Washington, researchers have found that screening, when combined with programs that coordinate treatment, does help many adults who are struggling with depression and who would otherwise receive little or no care.
But in May, the Preventive Services Task Force, a federal panel of experts that advises doctors and the government on screening guidelines, concluded that there was not enough evidence to recommend a similar kind of screening for suicide risk. The controversy is not likely to be settled soon.
''I have been getting a lot of attention on this, and it runs across the political spectrum, from civil libertarians on the left to Christians on the right,'' Representative Paul said. ''I think the idea of screening people, of asking these kinds of questions, rubs people the wrong way, and particularly when it's their children.''
Officials in New York, however, defend their initiative.
''Depression is a leading illness in New York City, but it can be effectively treated,'' said Dr. Thomas R. Frieden, the city's health commissioner. ''Our surveys show that there are an estimated 400,000 New Yorkers with depression; many have not been accurately diagnosed or effectively treated.''
MHTF Meeting Minutes
12 April 2005
In Attendance: Thais, Jenny, Dan, Nicole, Erin, Temina, Rob
Campuswide Committee: Dan and Nicole will work on a draft report to Steve Lustig, to be circulated through the MHTF mailing list for comments next
week.
Mental Health Survey: Jenny & Brian will continue analysis for publication, with caveat that all data should be normalized to national averages (Chancellor's recommendation). Upcoming conference: ACHA. Any others? We'll keep track of which campuses are using our methodology, for future grant applications.
CPS Advisory Committee: Next meeting, we need to follow up on the
following:
1- $5k for student-driven outreach, from new health fee
2- MHTF members on hiring/search committees
3- Implement psych referral follow ups
4- Add psych referral questions to annual UHS user survey
5- Request past data & trends at CPS
6- Changing how we ask about suicide (context?)
Before the next meeting, Erin will email Sue Bell and ask for updates on past initiatives (online depression screening, etc).
Outreach & Education: Poster to be printed this week. Distribution TBD. Future outreach efforts should focus on educating faculty/GSIs, reaching international students.
Health Insurance Feedback: Temina will draft anecdote collection website. How many new face-to-face contacts must a student make before getting appropriate mental health care?
Semester Plan: GA is holding elections next month; we should draft proposal to request $, advocacy from new officers. Postcard or bookmark should be designed for new student orientations (SISS) or for GSI Orientation (Linda von Hoene). Fundraising ideas? Follow up with Erin by email.