Around 450 million people worldwide have mental or psychosocial problems, but up to a quarter of those who turn to health services for help will not be correctly diagnosed and will not, therefore, get the right treatment.
The whole process of care for people with major depression must be enhanced if we are to improve the lives of these patients, argue Michael Von Korff and David Goldberg in this week's BMJ. Research shows that enhanced care reduces symptoms and disability, that it is more cost-effective than usual care, and that the costs of improving care are modest per case treated.
Yet change is hard work for overtaxed health care teams, and many might be tempted to adopt quick and easy quality improvement strategies that do not usually work, they write.
Instead, the evidence suggests that efforts to improve the primary care of major depression should focus on low cost case management together with a fluid and accessible working relationship among the primary care doctor, the case manager, and a mental health specialist. This model allows most depressed patients to access effective treatment in primary care, while the minority needing ongoing specialist care can be identified and referred more reliably.
Enhanced care for people with depression will go a long way towards improving the lives of these patients, they say. But the large gap in the quality of care cannot be closed only by the increased efforts of individual practitioners who are already overburdened, with many frustrated and demoralised.
The question now is whether insurers and organisations that provide patient care will act on the scientific evidence to benefit the millions of people worldwide who are afflicted by major depression, they conclude.