Momentum develops to put mentally ill in mainstream careers [The Pittsburgh Tribune-Review]

Nov. 3--After Saya Krebs was diagnosed with mental illnesses, her psychiatrist told her she should never work again.

For Krebs, 48, of Murrysville, it never made sense to drop years of training and experience to sit around and do nothing or work a low-skill job. And mental health professionals have learned in recent years that returning to work is often a critical part of their patients' recovery.

"I don't want to end up in one of those positions, the three F's, filing, food and filth. I want competitive employment. I want to work where I want, not just where my psychiatrist wants to send me," said Krebs, who suffers from bipolar and dissociative identity disorders and is a training coordinator at Community Care Behavioral Health Organization. "It's important to still be the wife and mother. I don't want that diagnosis to overshadow who I am."

Allegheny County and human service agencies around Pennsylvania are trying to shift their model for mental health recovery, encouraging people on a path back to work just like Krebs once took. Instead of sheltering the mentally ill in low-skill, subsidized jobs, state and local officials want to help more people find competitive employment in the mainstream work force. For government, it's cost-effective. And for mentally ill people, it helps build confidence, develop social skills and regain a sense of normalcy.

Krebs and several experts spoke Monday during the Regional Recovery Conference at the Pittsburgh Marriott City Center. Organizers expect more than 500 people to attend the conference, lasting through Wednesday, designed to promote the modern approach of pushing mental health patients beyond treatment.

"People with mental illnesses are just like everyone else. They want to get out; they want a career," said Mike Gruber, the system transformation coordinator at the county's Office of Behavioral Health. "They want to support themselves and they want to support their families."

Gruber is working to create a system in the county to help people compete for jobs where they can branch out and learn from experience in mainstream society. County officials will be hearing final proposals during the next two weeks, he said.The county will score the pilot proposals in 15 areas, including how well treatment is integrated with the job experience, how quickly patients can start their job search and how much freedom they have to choose their jobs.

Life'sWork of Western PA is one of three providers that could be part of the program. Its proposal includes universally useful skills like interview and resume training, and peer support groups to help people overcome their fears about returning to work, said Everett McElveen, president and CEO.

"We've never been keen on 'Just go to your therapist and then stay home,'" McElveen said. "You see the change in (working) people from the first day you meet them. Their self-esteem, the difference in confidence, you see it grow just from having a job, holding a job, getting out there again into that normal course of life."

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Telephone-based Depression Treatment Program Effective While Cost Efficient

Science Update: October 16, 2009: Patients who receive structured, telephone-based support to manage their depression gain significant benefits with only moderate increases in health care costs compared to those who receive usual care, according to an NIMH-funded analysis published in the October 2009 issue of the Archives of General Psychiatry.

Background

Previous research found structured depression treatment programs in primary care to be effective, but the success of their dissemination likely will depend on whether benefits can be balanced with costs, according to researchers at Group Health Research Institute in Seattle led by Gregory Simon, M.D., M.P.H.

Simon and colleagues conducted a randomized controlled trial of a telephone-based depression treatment program within one health care plan. Between November 2000 and June 2004, 600 patients were randomly assigned for two years to one of three depression treatment groups:

·          telephone care management that included outreach calls for monitoring and support;

·          telephone care management plus telephone-based cognitive behavioral therapy (CBT); or

·          usual care, which consisted of follow-up by a primary care provider and referral to a mental health care specialist.

Previously published data showed that telephone care management plus CBT yielded the most significant and sustained improvements in depression, while the care management program alone showed modest improvements.1, 2 This most recent paper examined the cost effectiveness of the program.

Results of the Study

When compared to usual care, participants who received telephone care plus CBT had 46 more depression-free days at an increased cost of $397 over usual care. Those who received just telephone care had 29 more depression-free days at an increased cost of $676 over usual care. Costs included outpatient depression treatment as well as health care plan costs for all other outpatient services. Although adding CBT to telephone care management required more upfront costs, it led to more significant and sustained improvements, and therefore, more modest costs overall.

Significance

The findings offer some guidance to insurers and health care systems that are considering ways to improve depression care. Both interventions led to increased spending over usual care, but the costs were balanced by improvements in depression symptoms, potentially allowing for improved worker productivity.

What's Next

Additional research is needed to determine to what extent depression and depression treatment affect other economic factors such as work productivity and burden on families. In addition, findings may be different among health care plans that calculate mental health care costs separately from overall health care spending.

References

Simon GE, Ludman EJ, Rutter C. Incremental benefit and cost of telephone care management and telephone psychotherapy for depression in primary care. Archives of General Psychiatry. 2009 Oct; 66(10):1081-1089.

¹Simon GA, Ludman EJ, Tutty S, Operskalski B, Van Korff M. Telephone psychotherapy and telephone care management for primary care patients starting antidepressant treatment: a randomized controlled trial. Journal of the American Medical Association. 2004; 292(8): 935-942.

²Ludman EJ, Simon GE, Tutty S, Von Korff M. A randomized trial of telephone psychotherapy and pharmacotherapy for depression: continuation and durability of effects. Journal of Consulting and Clinical Psychology. 2007; 75(2): 257-266.