Integrated care: A population-based approach to consultation-liaison psychiatry

Abstract

Ms. F is a 44-year-old Caucasian woman who was seen in an academic internal medicine clinic for treatment of uncontrolled type 2 diabetes mellitus. The integrated mental health team had noticed from their database that Ms. F’s PHQ-9 depression screening scored above 20 on her last two visits, signaling that perhaps she was experiencing moderate to severe depressive symptoms. However, the team saw that she was not receiving any evidence-based treatment for depression, neither medication nor brief therapy. The behavioral health care manager assigned to the internal medicine clinic contacted internal medicine resident Dr. C to offer assistance. Dr. C had already received extensive training from the consulting psychiatrist and care managers about diagnosing and treating depression, had confidence in prescribing and managing antidepressant medications, and knew how to access brief evidence based-psychotherapies that were being provided in primary care and in the community. Dr. C indicated that he had already diagnosed Ms. F as suffering from a major depressive episode when she had a PHQ-9 score of 21 at a previous visit. He remembered that she was very tearful when he had warned her about the high likelihood of diabetic complications if she did not adhere to the recommended diet, exercise, and medications. However, he stated that Ms. F had minimized her depressive symptoms and had blamed her tearfulness on the clinic staff who she claimed “just want to run my life.” Ms. F also refused both treatment with an SSRI and a referral to brief individual therapy.