I usually address mental health every October for Mental Illness Awareness Week (October 7-10) and National Depression Screening Day (October 5). Asking about an individual's psychological well-being is an integral part of each patient encounter (regardless of the reason for the visit). This year, however, I have noticed a sharp increase in patient requests for psychotropic medications, even among my established primary care patients who have always presented themselves as emotionally in control.
These patients might present with comments like, "I thought I could deal with this by myself, but I need something to help calm my nerves," "I sometimes feel so down I don't want to get out of bed in the morning," or, "I can't concentrate at work, and I'm afraid I might lose my job." Many have mentioned national and global events as primary reasons for new or increased psychological distress that affect emotions and mood, leading to subsequent nonproductive behaviors.
Healthy People 2020
One measure of the status of the nation's health is through Healthy People 2020 objectives. The midterm review of success in meeting goals was published online January 11, 2017.1 Chapter 28 presents statistics on mental health and mental disorders (MHMD).2 Of 15 measurable objectives in the categories of mental health status improvement and treatment expansion, 2 (13.3%) had met or exceeded the 2020 targets; 4 (26.7%) had demonstrated little or no detectable change; 5 (33.3%) were getting worse; and 4 (26.7%) had baseline data only.
The overall age-adjusted suicide rate (MHMD-1) from 2007 to 2013 increased from 11.3 to 12.6 deaths per 100,000, respectively, moving away from the target of 10.2. Only baseline data were available for MHMD-11.2 (screening for depression in youth), yet 3 of the 5 objectives that got worse were related to adolescents ages 9 to 17. The proportion of adolescents ages 12 to 17 with a major depressive disorder episode in the past 12 months (MHMD-4.1) increased from 8.3% in 2008 to 10.7% in 2013, moving away from the target of 7.5%.
During the same time frame, there was no detectable change for adults age 18 and over with a major depressive disorder episode in the past 12 months (MHMD-4.2), moving from 6.5% to 6.7% and not meeting a 5.8% target. Target goals for receiving treatment in children and adults were also not met, and only baseline data were available for MHMD-5-the percent of primary care facilities that provide mental health treatment on-site or by paid referral (79.0% versus a target of 87.0%).
The two objectives that met or exceeded targets were MHMD-10-the proportion of primary care physician office visits by adults age 19 and over that included screening for depression (from 2.2% to 2.4% in 2010, meeting the 2.3% target) and MHMD-11.1-the proportion of individuals age 18 and over with co-occurring substance abuse and mental disorders who received treatment for both disorders (from 3.3% in 2008 to 4.2% in 2013, exceeding the 3.6% target).
Healthy People 2030 and beyond
These data bring several questions to my attention. Why is the target for screening for depression in primary care so low? Why are treatment targets not met when three-fourths of primary care facilities report they provide mental health services? Why are more resources not expended toward adolescent mental health? Healthy People 2030 objectives are being formulated now; the last round of public comment closed in September, but you can still review their progress to date and participate in the next round. The opioid crisis has heightened national efforts. If you are not already screening patients, kick-start a program this month to appropriately screen for depression and mental health and offer treatment. In January 2018, look for our new department on psychiatric mental health in The Nurse Practitioner, and as always, we invite your comments.
Jamesetta A. Newland, PhD, FNP-BC, FAANP, DPNAP
EDITOR-IN-CHIEF [email protected]
REFERENCES