Abstract
Issue
Depression is the leading cause of disability worldwide. People with mental health problems often do not feel comfortable to seek help from mental health professionals. Depression is often 'covered' with physical symptoms and patients first seek help from family medicine doctors.
Description of the Problem
Primary health care organized through mental health centers and family medicine service was base for planning of depression screening program. Program is supported by the Ministry of Health and Social Welfare in the Government of Republic of Srpska and the Mental Health Project in BiH (implemented by Association XY with support of the Government of Switzerland). Methodology and promotional materials were developed in the Public Health Institute. Outcome was improved health of the adult population at increased risk of depression. Program was implemented from June 2018 till December 2019 in ten primary health care centers. Mental health centers (MHC) sensitized and trained family medicine teams (FMT) for screening. FMT used Patient Health Questionnaire 9 (PHQ 9), MHC used the Hamilton scale for confirmation. Confirmed cases were measured for quality of life with the Q-LES-Q-SF. Both of questionnaires were used for control measurement after three months of treatment.
Results
Screening of 1037 patients resulted in 445 of them were referred, of which 310 patients came to the MHC, where depression was confirmed in 289 patients. In control measuring, 30% of the patients showed the absence of depression, with a significant improvement in the self assessment of the overall quality of life.
Lessons
Clear methodological guidelines and program adjusted to the organization of health care services, along with monitoring and evaluation, was crucial, and appreciated from health professionals involved. Regular communication of mental health centers and family medicine services was important in overcoming obstacles to get patients in the program, and maintain them.
Key messages
Stigma still prevents patients who need help to get to the mental health services. Sensitized and trained family medicine doctors, as first contact with patients, are crucial in early detection of depression and convincing patients to accept help and stick to treatment.
Expanding understanding of mental health recovery: effects of stigma and working alliance on the quality of life of persons with severe mental disabilities receiving community-based case management services
