Depression Care Pathway
Happy New Year for 2015!
3% of all young people from the teenage years to young adulthood experience severe depression but only a quarter of individuals receive any kind of treatment. In my NHS practice in the UK I have been able to assess young people promptly when they have been referred in by their GP but there has been too much of a delay in enabling them to access cognitive behaviour therapy with one of our therapists.
In our practice we have developed a Depression Care Pathway (PDF), the details of which can be found by downloading the document from the preceding link. It has three sections:
In the first we are trying to get young people seen promptly to unravel their depressive symptoms and other concurrent (co-morbid) psychological symptoms, but also to understand their social context and the complex factors e.g. traumas and abuse, drug/alcohol misuse, peer difficulties etc.
The second part focuses on engagement in a treatment plan in the first month. Professionals should be clear regarding the severity of depression and the degree of suicide risk, and the formulation (explanatory model for what might be going on for the individual). In some instances young people may need to see a doctor and be commenced on medication (usually fluoxetine or sertraline). There needs to be a review in the first 4-6 weeks to review progress. Most young people who are well engaged in therapy will recover but those who are not need further consideration in the form of further understanding their context, safety planning and possible involvement of other agencies e.g. social services. There needs to be regular assessment of a young person's progress at least every three months by the team that working with them and their family.
In the third phase, the focus is on recovery and relapse prevention through the use of CBT/ Mindfulness group work. Also in this third phase there is consideration of how to manage young people who are not recovering and may need assessment by an adult service once they pass their 18th birthday.