National Academy Urges Changes in Screening and Treatment of Depression

A National Academy of Sciences (NAS) report urging a more coordinated approach to prevention and treatment of depression in parents-because of its impact on children-hit the streets just as Congress began considering legislation to reform the US health insurance system. The NAS report made a number of recommendations for changing the approach of both public and private health insurers toward depression, although the front-line troops expected to deal with the problem are primary care physicians, who already treat 70% of patients with depression.

According to the report, conventional screening does not consider the impact of a parent’s mental health status on the health and development of the children, nor have models that incorporate multiple interventions (eg, collaborative care) for adults been tested for their effectiveness in serving parents. “In short, parental depression is prevalent, but a comprehensive strategy to treat the depressed adults and to prevent problems in the children in their care is absent.”

The advisory committee that wrote the report was made up of chair Mary Jane England, MD, child psychiatrist and president of Regis College, and 2 other psychiatrists. Dr England said, “We need to refocus our view of this illness through a broader lens that sees the whole family, not just the individual with depression.” The new vision for depression care will take significant policy changes, but the benefits will far outweigh the effort. Comprehensive services would be provided to both adults with depression and their children.

Specifically, the committee recommended that the Centers for Medicare and Medicaid Services (CMS) extend coverage for mothers in the Medicaid program to 24 months postpartum. CMS could remove restrictions on Medicaid’s rehabilitation option and other payment options (including targeted case management and home visitation programs) that could reimburse services and support in nonclinical settings and enhance access to quality care; allow same-day visit reimbursement for mental health and primary care services; reimburse primary care providers for mental health services; and remove prohibitions on serving children without medical diagnoses, thereby covering health promotion services for children at risk before diagnosis.

Chris Koyanagi, policy director, Judge David L. Bazelon Center for Mental Health Law, said, “Restrictions on rehab and targeted case management have already been lifted by CMS and the issue of paying for 2 visits on the same day is one we are discussing with them. There is no federal prohibition here, but many state Medicaid programs do have that constraint.”

Andrew Sperling, director of federal legislative advocacy for the National Alliance on Mental Illness, stated, “There is lots of talk in health reform about Medicaid expansion-for eligibility up to 133% of the FPL [federal poverty level]. However, there is virtually no discussion of expanding either mandatory or optional services states are obligated to-or would have the option to-cover under their Medicaid programs.”