NYC doctors group has been screening for depression for three years

NEW YORK — A federal task force's recommendation that primary care doctors screen all adult patients for depression was surprising but a “very, very positive development," says Henry Chung, a psychiatrist who is chief medical officer at the Montefiore Health System's care management organization here.

“The landscape has changed when it comes to expectations of primary care doctors,” says Chung. “They should have system supports in place even if it’s just going to be a nurse who engages with the patient and makes sure they get to a trusted referral.”

Chung would know. Montefiore has been linking depression screenings with primary care for the past three years through a federal Centers for Medicare and Medicaid Services innovation grant to fund integration of behavioral health into its primary care services.

Asif Ansari, an primary care doctor who is medical director for one of Montefiore primary care sites, says physicians have long known how prevalent depression is, but often thought  didn’t have the time or resources to address it.

Task Force: Doctors should screen all adults for depression

“The issue is we’re dealing with their depression, their high blood pressure, their high cholesterol, their colonoscopies, their screening for their mammogram, their blurry vision and anything they come in for,” says Ansari. “So to stop and say, ‘have you been feeling down?,’ is a little bit of an unrealistic expectation in a 15 to 30-minute meeting.”

Besides, he says, “you don’t ask if you don’t have some help to offer,” given the national shortages of psychiatrists and other mental health providers.

The task force’s previous recommendation recognized that most primary care doctors wouldn’t have a system in place to address depression. 
All patients at Montefiore’s primary care facilities fill out questionnaires about depression and possibly a longer one depending on their answers. 
Montefiore has psychiatrists working with teams of social workers, nurses and primary care doctors to treat patients who screen positive.

About three years ago, Ansari’s patient Maureen Ramdass was laid off from her job and her husband developed kidney failure and could no longer work. Ramdass was working long hours and ignoring her health. She is now getting treatment for diabetic neuropathy, asthma, arthritis and depression.

“I felt so overwhelmed with everything that was going on," says Ramdass. “I felt like everything was caving in, I had so much depression.”
Now that she has received treatment and meets with a social worker at Montefiore, “I feel in my heart they have helped me.”