| Pointers for development | Recommendations |
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| Stepped care and collaborative care are appropriate models for the management of depression in Scotland. Guided self help has proved to be a useful first line intervention for many of those with mild to moderate depression | The implementation of stepped and collaborative care models in primary care should be promoted to address depression and common mental health problems The Doing Well work should inform the planned development of Integrated Care Pathways for Depression |
| There is a need to promote understanding of a range of psychological and psychosocial interventions in primary care, including guided self help, to enhance their acceptability and relevance to referrers and potential users. This includes identifying those groups for whom guided self help is neither engaging nor effective | The Health Department and other national bodies should support the implementation of the interventions piloted in Doing Well by actively promoting the changes in attitudes and behaviour required for the effective use of guided self help (for example by sponsoring awareness raising and training in self help models). Further research and development is required to identify how best guided self help can be adapted and enhancedfor a wider range of groups; acceptable alternatives where guided self help is not indicated |
| Community Health Partnerships are likely to need support to maintain the appropriate level and quality of staff training and supervision for the delivery of psychological interventions, including guided self help | CHPs would benefit from national guidance and support to create and maintain capacity for psychological interventions Steps should be taken to ensure that training for health care professional incorporates sufficient attention to psychological therapies |
As part of a national initiative that fosters locally driven service innovation within a common framework of aims, there is considerable added value to be derived from offering local participants a range of tools and supports to facilitate change processes | Implementation of future national redesign and service development initiatives should include support with project management, as well as the provision of opportunities for networking and learning The Doing Well Development Network should develop wider links with other relevant initiatives on primary mental health care, to continue to bring together experience from practice and evidence from research in a range of fields relevant to the management of depression and common mental health problems Stepped care and collaborative care are appropriate models for the management of depression in Scotland. Guided self help has proved to be a useful first line intervention for many of those with mild to moderate depression |
| Service redesign methodologies can have application and utility in mental health and the experience of Doing Well can be built on in future work on system redesign and service improvement | The lessons from Doing Well should inform the development and implementation of the Delivery Plan for Mental Health in relation to primary mental health care |
| To learn from innovation requires meaningful data and the selection of outcome measures that can identify the systemic impact of interventions | It is essential to incorporate consistent data collection systems, including appropriate outcomes measures, into national initiatives from the earliest possible stages |
| There is a need to ensure complementarity and synergy among nationally initiated developments, e.g. tackling stigma, raising awareness, preventing suicide | The learning from Doing Well should be linked to other national priorities for mental health improvement, including Choose Life |
| Pointers for development | Recommendations |
|---|
Depression is a complex problem, which requires a range of responses and interventions, both from the health sector and from its community and voluntary sector partners. Stepped collaborative care provides a useful and viable model on which to build Resources such as guided self help have a valuable role in the repertoire of responses and services required to treat and support people with depression but are not the only solution | CHPs should review the range of options and pathways in place and identify unmet needs and areas for improvement. This should include identifying how to strengthen current capacity and capability in health and social care and in the community and voluntary sectors and where necessary realign roles The development of pathways for people with depression should include attention to the rationalisation of prescribing practices |
| Innovation can be a means to further strategic goals by bringing about changes in how service system works. It is an opportunity to test out ways of working that can be absorbed into mainstream activities (rather than to create projects which then require long term funding) | CHPs should invest in systems to generate data that can serve as a tool to inform planning and development To enhance the sustainability of interventions for depression, CHPs should look for connections with other agendas and strategies, e.g. health improvement and the management of long term conditions |
| Getting and keeping the engagement of key stakeholders requires sustained effort and is vital for system change. Achieving change in the attitudes and behaviour of practitioners and the public is not simple and has to be tackled at different levels over the long term. It is not only a matter of offering training or distributing information about the value of guided self help | CHPs should work with local stakeholders to agree goals for change and to design appropriate local solutions, recognising that these may include interventions at individual and community level and may involve a range of service providers, not only the NHS |
Research can help with understanding the problems to be addressed, the features of effective interventions and models for delivery | In planning and developing services and resources for common mental health problems including depression, CHPs should draw on a range of bodies of research evidence on: clinical interventions, models of service delivery, mental health promotion and prevention |