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Letters to the Editor   |    
Practice-Based or Telemedicine-Based Collaborative Care for Depression
Henry White, M.D.
Am J Psychiatry 2013;170:926-926. doi:10.1176/appi.ajp.2013.13040471
View Author and Article Information

The author reports no financial relationships with commercial interests.

From the Brookline Community Mental Health Center, Brookline, Mass.

Copyright © 2013 by the American Psychiatric Association

Accepted May , 2013.

To the Editor: In the editorial (1) accompanying the interesting article (2) on practice-based compared with telemedicine-based collaborative care for depression in the April issue of the Journal, Drs. Simon and Ludman frame the question explored by the study as: Which is better, “locally grown or factory-farmed?”

The study may have answered a rather different question: Which is more effective, supervised or unsupervised mental health treatment? The intervention used nurses with no prior mental health experience as depression care managers. Both the practice-based and the telemedicine-based nurses received an initial 1 day of training and a training manual. Thereafter, the telemedicine-based nurses received weekly supervision, which included a discussion of patients who were not responding to treatment. In contrast, the practice-based depression care managers received no clinical supervision.

The use of unsupervised nurses deviates from the standard practice of collaborative care of depression, which rests on the principle of collaboration between a depression care manager, the primary care provider, and a consulting psychiatrist (3, 4). The IMPACT Intervention Manual specifies that “The [depression care manager] should receive clinical supervision and consultation from a liaison primary care physician and from a team psychiatrist during a weekly team meeting at the primary care clinic” (5). The treatment provided by the unsupervised practice-based depression care managers was by no means equivalent to that of the supervised telemedicine-based depression managers.

It is premature, therefore, to conclude that “factory-farmed” is better than “locally grown.” Indeed, the study can be seen to demonstrate the unsurprising finding that providing weekly supervision and consultation to nurses with no prior mental health experience leads to more effective treatment and better outcomes.

Simon  GE;  Ludman  EJ:  Should mental health interventions be locally grown or factory-farmed? Am J Psychiatry 2013; 170:362–365
[CrossRef] | [PubMed]
 
Fortney  JC;  Pyne  JM;  Mouden  SB;  Mittal  D;  Hudson  TJ;  Schroeder  GW;  Williams  DK;  Bynum  CA;  Mattox  R;  Rost  KM:  Practice-based versus telemedicine-based collaborative care for depression in rural federally qualified health centers: a pragmatic randomized comparative effectiveness trial.  Am J Psychiatry 2013; 170:414–425
[PubMed]
 
Unützer  J;  Katon  W;  Callahan  CM;  Williams  JW  Jr;  Hunkeler  E;  Harpole  L;  Hoffing  M;  Della Penna  RD;  Noël  PH;  Lin  EH;  Areán  PA;  Hegel  MT;  Tang  L;  Belin  TR;  Oishi  S;  Langston  CIMPACT InvestigatorsImproving Mood-Promoting Access to Collaborative Treatment:  Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial.  JAMA 2002; 288:2836–2845
[CrossRef] | [PubMed]
 
Improving Mood-Promoting Access to Collaborative Treatment: IMPACT key components. http://impact-uw.org/about/key.html
 
Unützer  J;  Oishi  SIMPACT Investigators:  IMPACT Intervention Manual .  Los Angeles,  Center for Health Services Research, UCLA Neuropsychiatric Institute, 1999
 
References Container
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References

Simon  GE;  Ludman  EJ:  Should mental health interventions be locally grown or factory-farmed? Am J Psychiatry 2013; 170:362–365
[CrossRef] | [PubMed]
 
Fortney  JC;  Pyne  JM;  Mouden  SB;  Mittal  D;  Hudson  TJ;  Schroeder  GW;  Williams  DK;  Bynum  CA;  Mattox  R;  Rost  KM:  Practice-based versus telemedicine-based collaborative care for depression in rural federally qualified health centers: a pragmatic randomized comparative effectiveness trial.  Am J Psychiatry 2013; 170:414–425
[PubMed]
 
Unützer  J;  Katon  W;  Callahan  CM;  Williams  JW  Jr;  Hunkeler  E;  Harpole  L;  Hoffing  M;  Della Penna  RD;  Noël  PH;  Lin  EH;  Areán  PA;  Hegel  MT;  Tang  L;  Belin  TR;  Oishi  S;  Langston  CIMPACT InvestigatorsImproving Mood-Promoting Access to Collaborative Treatment:  Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial.  JAMA 2002; 288:2836–2845
[CrossRef] | [PubMed]
 
Improving Mood-Promoting Access to Collaborative Treatment: IMPACT key components. http://impact-uw.org/about/key.html
 
Unützer  J;  Oishi  SIMPACT Investigators:  IMPACT Intervention Manual .  Los Angeles,  Center for Health Services Research, UCLA Neuropsychiatric Institute, 1999
 
References Container
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