Depression is underdiagnosed and undertreated
A staggering fact about depression is the low rate of diagnosis and treatment. There has been recognition that many doctors may not look out for depression sufficiently in their patients, and several medical societies are to be congratulated in creating more awareness and training of physicians to help avoid underdiagnosis. But barriers to diagnosis also come from people affected, with many of them unwilling to seek help – for a host of reasons that can be very individual.
What is sobering, but also provides hope, is that better prevention and care could have a real dent on depression: greater prevention would reduce the incidence of depression by 21%. Providing all people with depression with evidence-based treatment would reduce the disease burden by a third. The key is to reach people at risk and encourage them to seek help and receive appropriate treatment.
Removing stigma and encouraging empathy: the way forward
In 2018, HPP was commissioned to undertake a project on depression, collaborating with nine leading organisations working in the field of mental health across Europe. Throughout our discussions about iterative drafts of the report and in our interviews with clinical experts, patient representatives and leaders of innovative programmes tackling depression, two words kept coming up: stigma (the need to combat it) and empathy (the need to develop it).
The word ‘stigma’ is possibly overused in the health policy lexicon – so much so, as was stated by an esteemed psychiatrist working on this report, that it has become stigmatising in itself. Stigma for depression is pervasive, despite many people – including celebrities – bravely coming forward and talking about their own experiences with depression. Author JK Rowling told Oprah Winfrey about her own mental health, emphasising the difficulty many people with depression find in explaining what they are going through:
‘[Depression] is so difficult to describe to someone who’s never been there, because it’s not sadness.
Sadness is not a bad thing – to cry and to feel – but it’s that cold absence of feeling, that really hollowed-out feeling.’
The impact of stigma will be profoundly felt by those seeking care, and can therefore be a huge barrier to seeking help. How many of us would be happy to admit that we need to visit a mental health clinic? Compounding this, in a system like the UK’s National Health Service, where people have to jump through various hoops to seek appropriate specialist care, getting help may involve being passed from GP to specialist to another specialist. One of the people we interviewed highlighted that it’s crucial to make it easy for people with depression to seek help – both to reduce the personal burden on them, and to avoid the risk that they get lost in the system.
The flipside of stigma is empathy: we all need to care more about depression. We should care about people with depression the same way we care, profoundly and emotionally and without judgement, about people affected by cancer or heart disease. But it’s not just about having empathy for others; the need for empathy starts with individuals affected. One incredible project we featured as a case study in our report was a programme in Finland for people who had attempted suicide. The programme involved videotaping people while they talked about why they had attempted suicide, and then playing the video back to them so that they could hear themselves articulate what was at the root of their suicidal thoughts. The longer-term aim was to enable people to have empathy for themselves – and thereby give them both the belief that they could help themselves and the tools to do so.
It is tricky to put in a call to action to policymakers: we all need to care more about depression. But we do. We have, undoubtedly, come a long way in our understanding, social acceptance and – yes – empathy for mental illness and those affected by it. But it is still, understandably, very scary for most of us. We need to recognise that this fear, coupled with misconceptions of what depression is and what we can do about it, creates barriers to progress and thwarts empathy. And empathy is key to overcoming some of those intrinsic barriers to curbing the growth of depression in our societies. This isn’t just an issue of policy. It’s a call to action to us all.
The opinions expressed in this blog are those of the author and do not necessarily represent the views of The Health Policy Partnership.