ASSESSING THE STATUS OF INDIVIDUALS WITH DEPRESSION
Recovery is about individuals taking control of their own lives and not having others determine their care or treatment. The concept has evolved to mean the process by which an individual comes to terms with [an] illness and learns to cope. Recovery does not imply a cure but a life long journey and process.
A. KATHRYN POWER, M.ED., DIRECTOR,
CENTER FOR MENTAL HEALTH SERVICES
This section explains the procedures for discharge and continuation of care. It also identifies ways that therapeutic approaches are being evaluated and standards that are in place to ensure quality care.
Successful Discharge/Care Coordination
Psychiatrists have become quite comfortable working with a multidisciplinary team. Members of the clinical team, including primary care physicians, nurses, psychologists, occupational therapists, social workers, care managers and peer counselors, have become integral in the assessment process. The work performed by the treatment team allows the psychiatrist to integrate the information into his/her assessment and treatment plan. This observation of individuals’ behaviors in numerous settings improves and enhances the overall picture of the individuals’ needs and conditions.81
Hospitalization may be needed for the individual experiencing psychosis or high suicidal tendencies. Nonetheless, the least restrictive level of care is a priority. Since there are so many co-occurring medical issues, the individual with depression may end up being hospitalized for one of these medical issues. It is important that the care management team acknowledge depression treatment as a priority, on a par with care for medical issues.
When making decisions or planning the next level of care, the issues to consider are the following:
A plan for monitoring potentially dangerous behaviors or thoughts.82
Assessment of the individual’s self-care abilities and home/living situations prior to hospitalization.
Strategies for continued monitoring with input from the individual, providers, and the individual’s support/caregiver.82
Before transition to a lower level of care can take place, the depressed individual and support system should be assessed for knowledge related to depression, medications, and warning signs of relapse.82 Assessment regarding the ability to return to work, school, or other usual activities is helpful. A crisis plan should be developed, and any firearms should be removed from the residence.83