The Family Mental Health Institute (FMHI) in Washington, D.C. is working on a number of interesting projects to further our mission to make Universal Depression Screening and Treatment a standard of care throughout the United States. As health care is a state issue, each state will have to develop and implement its own plan. So far, the state of New Jersey has passed legislation for mandatory universal depression screening in all primary care practices as well as training. They have budgeted $13 million/year to carry out the program. FMHI, under the leadership of Dr. Barbara Hatcher, director of Learning and Global Education for APHA, is inaugurating a campaign to add 10 new states to the list by 2010.
FMHI has a rough draft of a training manual that can be used by the full spectrum of health care workers who come into contact in MCH settings. We are seeking a national sponsor, such as a diaper or baby food company, to publish and distribute it at no cost to MCH facilities that need it. Also, the FMHI Web site, www.PPDhope.org, has undergone a major update. It includes an interactive version of the Edinburgh Postpartum Depression Scale (EPDS) without the actual scoring, which can be used to educate women and to encourage them to seek professional help.
Eastern Shore: FMHI has also collaborated with the Mental Health Association of the Maryland Eastern Shore (MHAMDES), under the leadership of their executive director, Tina Mills, to develop an area-wide universal depression screening and treatment program. MHAMDES formed a coalition of over 13 different organizations, including two major health care systems, three community colleges, all local hospitals and birthing centers, and many individual practitioners. FMHI provided multiple presentations in the region, including Grand Rounds at the hospitals in the three regions of the Eastern Shore, presented by Dr. Ralph Wittenberg, medical director of FMHI, and presentations about the need for screening to all three area hospitals, the public, and classes for nurses and social workers by Dr. Wittenberg and FMHI Past President Cheryl Hall, with CEUs available under the sponsorship of Chesapeake College and the Psychology Club of Washington College. Dr. Wittenberg has also attended the meetings of the Perinatal Psychiatric Coalition. The state of Maryland has funds available to support mental health projects in rural areas, and since the Eastern Shore of Maryland is a rural area, MHAMDES and FMHI are going to partner in applying for those funds.
Healthy Start in Washington, D.C.: FMHI had a federal grant for four years through the Healthy Start Program of the Health Resources and Services Administration (HRSA), under the aegis of the Division of Maternal and Child Health. The purpose of the HRSA grant was to establish the feasibility of Universal Depression Screening. FMHI has shown that this can take place in an assortment of settings, using a variety of personnel. In addition, when screening takes place it creates the impetus to develop treatment programs.
From the outset, FMHI worked with Mary’s Center for Maternal and Child Health in Wards 1, 2, and 4 in Washington, D.C., including the Healthy Start Initiative and Healthy Families Program. During the period of the grant, Mary’s Center began collaborating with other health centers, organizations, and medical services, such as the Children’s Hospital National Medical Center Outpatient Department, Providence Hospital, and the Unity Health Care Upper Cardozo Center in Columbia Heights, an under-served area of D.C. This expanded the reach of Mary’s Center from about 200 mostly Latina patients to several thousand under-served inner city patients. They instituted universal depression screening using both Healthy Start case managers and Healthy Families home visitors. They also developed a mental health program to care for these patients, as there were no appropriate treatment facilities available in the city.
Screening now standard of care in the Navy: The Universal Primary Care Perinatal Depression Screening program, started in 2001 in conjunction with the National Naval Medical Center, has been officially made the standard of care throughout the entire U.S. Navy. The protocol uses the Edinburgh Postpartum Depression Scale twice during pregnancy as part of OB prenatal care, and four times postpartum. Three of the postpartum visits are part of well baby clinic follow ups on the Pediatric Service and one is at the six week OB postpartum visit. Patients who score 12 or higher are then reported to the primary care physician and referral is made to either the Mental Health Activity (comprised of psychiatrists and psychologists), or the Department of Social Work. Initially case management was done by nurse practitioners, but is now done by corpsmen. It is an instruction (i.e., an order) that is part of 2007 military spending act. Lt. Commander Marlene Sanchez says that that the other service branches are being urged to develop the same standard of care. The architect of this plan, Dianne Bloom, an OB nurse practitioner and director of the Prenatal Assessment Clinic, says that the program is continuing, but is under stress as a result of increased need for casualty care and deployment of hospital staff to the Hospital Ship, Comfort.