Implementing Screening as Part of Enhanced Care: Screening Alone is Not Enough

There are conflicting conclusions and policy recommendations relating to the effects of screening on the outcome of depression, but what does the latest evidence suggest? Based on the best available information to date, it emerges that screening alone is not a sufficient intervention to improve the quality and outcomes of care for depression. What is less clear is whether screening is a necessary condition for enhanced and improved quality of care and, given additional components, to what extent screening programs can potentially improve quality of routine care. Depression is the most common mental health problem and is associated with decrements in functioning and quality of life comparable to other chronic physical diseases. The prevalence, chronicity, and burden of suffering are such that the World Bank has predicted that depression will become the second leading cause of global disability by 2020. The economic consequences of depression are also profound, with the healthcare costs, welfare costs, and losses to productivity amounting to £9 billion ($20 billion) in the United Kingdom3 and $53 billion in the United States. Depression is most commonly encountered in primary care and in hospital settings, yet it often goes unrecognized by healthcare professionals. This has led to calls to implement screening programs to aid in the detection and management of this problem. The rationale and evidence base to support screening for depression is the focus of the present book and is discussed extensively in other chapters (see Chapters 2, 4, and 9). In the United States, screening has shifted from being an intervention that was not initially supported in national policy recommendations to being one that is regarded as being of proven effectiveness. An evolution in thinking has occurred that places screening at the center of mental health policy and practice, and is based upon the general assumption that screening will logically lead to improvements in the quality and outcome of care. Some have termed this the screening– detection–treatment–improvement paradigm. Recently screening for common mental health problems in the United States has become the cornerstone of the president’s agenda to improve the mental health of the U.S. population.