Post by Former NIMH Director Thomas Insel: Collaborative Care
When asked about how NIMH research can change mental health care, I have a short list of “best hits” that I offer as examples. High up on that short list is collaborative care. Developed initially for treating depression, collaborative care integrates mental health and primary care to provide patient-centered, comprehensive, accountable care. To ensure that patients receive comprehensive and evidence-based care, each patient has a team, including primary care providers and mental health specialists, monitoring progress, with clinical and community support for reaching treatment goals. Not only does each patient’s treatment plan articulate personal goals that are routinely measured by tools like the PHQ-9 depression scale, but treatments are actively changed if patients are not improving as expected until the clinical goals are achieved.
When asked about the development of collaborative care, I always think about Wayne Katon. Wayne died earlier this week after a heroic struggle with lymphoma. Our field has lost a brilliant, effective, innovative leader. Wayne led the team that conducted the first large randomized controlled trial of the collaborative care approach for depression. Since its original publication in JAMA in 1995,1 randomized controlled trials around the world, more recently in low- and middle-income countries, have validated the effectiveness of this approach.
NIMH provided support for much of Wayne’s work during his 35 years in the Department of Psychiatry and Behavioral Sciences at the University of Washington, where he created and led the Division of Health Services and Psychiatric Epidemiology. He was famous as a gifted mentor and clinician, as well as a scientist with a relentless commitment to improving depression treatment.
As noted by Jürgen Unützer, chair of the UW Department of Psychiatry and Behavioral Sciences, today the collaborative care model pioneered by Wayne and his research team puts effective depression care in reach for millions of people living with depression around the world. The greatest tribute to Wayne’s legacy will be the broad implementation of collaborative care during this era of mental health care reform.
1 Katon W et al. Collaborative management to achieve treatment guidelines. Impact on depression in primary care. JAMA. 1995 Apr 5;273(13):1026-31.