In January, we shined our ‘Spotlight’ on Marcus Daly Memorial Hospital (MDMH). The community-based hospital serves a rural community in Montana, and they have had great success increasing their depression screenings by 60% in 12 months. As we acknowledge World Suicide Prevention Day on Friday, September 10, we talked with Mira McMasters, Quality Director at MDMH to learn more.  

 

Why did MDWH begin placing more emphasis on the Depression and Follow-Up measure? 

A team had been established to work on a project that would be given dedicated time and support.  When the different initiatives were discussed, a recent teenage suicide in the community weighed heavy on many of the member’s minds as well as their own personal connections of people with depression.  The team knew, at that time, Montana had the highest suicide rate in the nation per 100,000 people.    Another contributing factor- this was an ACO measure we were doing poorly on.  If we ever wanted to work on the depression remission measure, we knew we needed to start identifying who were depressed.  
 

What the team learned in the process provided added commitment.  Depression is one of the most treatable of all psychiatric disorders.  Even more sobering was that up to 45% of individuals who die by suicide visit their primary care provider within a month of their death, with 20% of those having visited their primary care provider within 24 hours of their death. 
 

What were some of the biggest challenges you experienced? 

We thought initially that we just needed to identify who was depressed and then take care of the patient. But, if you want to make a meaningful change to help someone, that approach was naive. The team quickly adapted to many challenges: 

  • Depression had a stigma and many staff members felt uncomfortable even asking the PHQ-2 and PHQ-9 questions. The staff needed to get as comfortable asking the screening questions as taking vitals.  

  • There was a false sense that our community did not have resources when in reality we had more resources than other communities. We needed to make it easy for providers to refer to other resources when appropriate. 

  • Because we are a CAH, we implemented depression screening to the Emergency Department, Inpatient, Swingbed, Specialty Clinics and Rural Health Clinics. For some providers, clinical studies helped. Others required a Medical Staff approved policy. 

 

What advice do you have for other practices interested in increasing this measure? 

  • Create a committed interdisciplinary team that will meet regularly with a clear scope of the project and make sure your culture is stigma-free regarding mental health. 

  • Education is essential. The facts are sobering, and you need get buy in from front line staff.  Otherwise, be prepared to answer questions like, “When did depression screening become the most important thing I do?” Contact your state public health or national organizations for how to roll out the program/education/speakers if needed.     

  • Take care of your employees and co-workers. Remember, the employees/providers represent your community and therefore your employees may have depression or may even be contemplating suicide. If we don’t take care of our own, they can’t take care of the community. 

  • Designate provider champion to talk to the other providers to roll out the plan, gain feedback on what is not working, and provide support. 

  • Don’t make this the flavor of the month.  Create a plan that will continue to monitor that the screenings are occurring, and providers have the resources to help the patients. 

    For more information about Caravan Health's population health methodology, watch our recent explainer video.

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