Brought to you by the Depression Is Real Coalition, The Down & Up Show is dedicated to the reality of depression. Our hosts will talk with some of the world's top experts on depression, as well as people who have been impacted by this illness. The reality of depression is that it is a debilitating and potentially deadly medical condition that affects more than 15 million Americans every year. The other reality of depression is that there is hope.

Down & Up Show #25: Screening for Depression

INTRO: The Down and Up Show on Depression is Real.org. A talk show dedicated entirely to the subject of depression; and the reality that there is hope for people living with this disease. Now your host, Dr. Rahn Bailey.

DR. RAHN BAILEY INTRO: Welcome. The Down and Up Show on Depression is Real.org. I'm your host, Dr. Ron Kennedy Bailey. Today we will speak with Dr. Douglas Jacobs about an important day in the mental health community — National Depression Screening Day — which will be this upcoming Thursday, October 11th, 2007. In 1991, Dr. Jacobs spearheaded the first National Depression Screening Day.

It was the initial large-scale public campaign of mental health education and screening. The National Depression Screening Day provides free, anonymous mental health screening at sites around the country. The event's success and Dr. Jacob's personal commitment with continuance (unint.) the founding of screening for mental health. Today Dr. Jacobs serves as the president and chief executive officer of that new organization.

In addition to his responsibilities at Screening for Mental Health, Dr. Jacobs is currently an associate medical professor of psychiatry a the Harvard Medical School and a nationally recognized expert on suicide and depression.

Welcome, Dr. Jacobs. Tell us a little bit about the day – the National Depression Screening Day — and how you got it started.

DR. DOUGLAS JACOBS ANSWER: Sure. Well, first, National Depression Screen Day is actually coming up — as you mentioned, it's October 11th – and it's held during Mental Illness Awareness Week where there's a general awareness about a variety of mental illnesses. But National Depression Screen Day is specifically a combination of screening and education that's conducted by hospitals, community mental health centers, colleges, primary care offices, military installations and community groups across the country. The essence of the program is that it provides free and it's free anonymous screening for depression, bipolar disorder, general anxiety disorder and post traumatic stress disorder. Those who tend the screening can watch a brief video, take a brief written questionnaire — which encompasses the four disorders that I mentioned, that doesn't take more than five minutes — they then pick up educational materials about the disorders which review the science and symptoms and the available treatments. And the important concept of National Depression Screen Day is that people get an opportunity to talk to a health professional about their screening results and any other concerns they have; and if people score positive on the screening test, they're then referred to resources in their community for evaluation and treatment.

DR. RAHN BAILEY QUESTION:It's that ability to refer to appropriate and available resources in the community. It's so important because I think that's another one of our struggles in this business: we do get persons out for assistance or care – maybe they see a provider or maybe someone who's non-psychiatrist, a clinical provider or a primary care doctor or the like or non-physician provider. If that initial assessment is made, if there's nowhere to refer them, I can only imagine what difficulties that may entail and actually lose someone (unint.) could've received appropriate care to prevent some of the function compromise that often occurs in their life. Talk a little bit about how you decided to start.

DR. DOUGLAS JACOBS ANSWER:Well, one of the things that we try to emphasize to our sites is that they review the multiple resources in their community; and over the 15 years that we've been conducting these screenings, in the majority of circumstances we understand that people have been able to be referred to available resources.

DR. RAHN BAILEY QUESTION:What are some of the symptoms that you might list for some listeners to our show today might hear and say: hey, I didn't really think that this may apply to me, but maybe it actually does.

DR. DOUGLAS JACOBS ANSWER:Well, I mean, that's an important question. One of the things to understand is that depression isn't specifically depression — and I'll go (unint.) — there are multiple disorders we screen for, but I'll limit myself to depression here. Depression is an illness, not a weakness. It impacts the body and the mind and our moods. The classical mood symptoms are feeling sad, down, empty, anxious. People have a loss of interest in usual activities. They have no joy in their life. It can affect their body. You can have changes in sleep, appetite, energy level tends to be down, people can be restless or irritable; and it affects the mind where people may begin to feel hopeless, worthless, helpless, have a great deal of guilt, have trouble concentrating or making decisions; and the most serious symptom of depression is thoughts of death or suicide. And that's a really important point to emphasize — that if someone who listens to this program is experiencing suicidal thoughts regardless of the number of symptoms that they may have, they should seek a professional healthcare evaluation immediately. The important part of depression is that it stays with someone for at least two weeks or more in terms of the persistent (unint.) — in terms of what we refer to as our diagnostic criteria. But depression can last six to nine months if it's untreated; and with treatment, improvement can occur in one to two months. So it makes a big difference because depression can impact our relationships, our work abilities and our health and then the tragedy of suicide.

DR. RAHN BAILEY QUESTION:(Unint.) working persons can go to find some more information about the event? Where can they go to get screened in general?

DR. DOUGLAS JACOBS ANSWER:Well, there are several ways to go about this. First of all, we have our screening site — our website — which is mentalhealthscreening.org. There are approximately a thousand sites participating in the screening a day and that people can find a site near them by clicking onto the site locator on our website. There are also primary care officers and so to check with one's primary care physician. But also on our website for a limited period, and I think for about a month, people can take the screening test for depression. And then they can bring that — they can bring the results — to their primary care physician or to their local hospital regardless of whether or not the facility is participating in National Depression Screening Day, because all today most hospitals across the country have the availability of providing psychiatric evaluations.

DR. RAHN BAILEY QUESTION:Is there a certain theme this year? Do you have like each year there's an annual focus on a particular aspect at National Depression Screening Day? (Unint.) this year to highlight, particularly?

DR. DOUGLAS JACOBS ANSWER:Yes, and, you know, in the past we focus it on the relationship between pain and depression or women and depression, men and depression. This year's theme is suicide prevention. We call it: Stop a Suicide Today. And it's really a combination of screening, education, suicide detection and education for both the public and professionals. We know the following about suicide: there are about 30,000 individuals each year who commit suicide in the United States. Less than 30 percent of those are in active treatment at the time. Seventy percent of people who commit suicide communicate their intention to a significant other and the significant other doesn't always know how best to handle that. Sometimes people will try to talk people out of feeling suicidal. We do not recommend that. What we recommend is that people listen to a loved one — if they're talking about suicide — demonstrate that you care; but the important point is get that person to treatment. We refer to that as our ACT (A-C-T) model — acknowledge, care, get to treatment. And what Stop a Suicide Today program does is that it allows the public to understand the signs and symptoms of suicide and how to get their loved one to treatment; so that theÉ This year's screening day is really two components. They're screening for persons who are concerned about themselves — whether or not they have depression — and then there's screening for friends and family who are concerned a loved one may be suicidal. And there's a suicide risk questionnaire that people fill out, and then depending upon the responses, a person would be given some guidelines as to how to get their loved one to treatment. There's the — and there's two areas there: one's voluntary to get that person to either an emergency room, primary care physician or a mental health provider. But there are times when it has to be on an involuntary basis and police have to be called — although that's in the minority of circumstances. Sometimes it is necessary when someone's life is in danger. The other part of our program here is that not only do we provide educational materials for the public, we also provide suicide assessment tools for healthcare professionals. We've been involved in developing a suicide protocol, we've been involved in developing guidelines for hospitals to adhere to the new Joint Commission on Hospitals for patient safety goals on suicide. So the unique feature of this program is both directed at the public and the healthcare professionals. DR. RAHN BAILEY QUESTION:If we have listeners today that are interested in supporting the program — either resources or volunteers or any number of types of (unint.) they could bring — how might someone help? DR. DOUGLAS JACOBS ANSWER:Well, I think part of itÉ One way to think about supporting the program is to go on our website and learnÉ educate oneself about the signs and symptoms of depression and suicide and if they're concerned about a loved one, to get that person to treatment or go for treatment themselves, and then they can either go to a screening site or they can go on our website and take the test and then bring that person to treatment in their area. DR. RAHN BAILEY QUESTION:Is there an organization that has a similar task — maybe or maybe not an (Unint.) or MHA. (Unint.)É mental health associations. There are other groups that have some components. Are there opportunities for them to connect with this entity and use their own membership numbers to support the project?

DR. DOUGLAS JACOBS ANSWER:Well, that's an important area. We do work with the national advocacy groups including Mental Health America, NAMI, you mentioned, which is the National Association of Mental Illness. There's the American Association of Suicidology (ph.). So we do work with these organizations. There's an organization called SPAN, which is the Suicide Prevention Action Network, that who create an awareness in the public that these illnesses — when I say these illnesses, specifically the illness of depression — is under-diagnosed, under-treated; and that treatments are available. I think that's been the key point that people need to understand is that they don't need to suffer with these symptoms of depression, the illness of depression, and that treatment is both available and safe.

DR. RAHN BAILEY QUESTION:I mentioned the organizations like yours — screening for mental health, that's part of their role — information, education (unint.) this kind of information out. What are some other roles or what are the activities of screening for mental health as an organization

DR. DOUGLAS JACOBS ANSWER:Well, we have a number of activities. We have bothÉ there are in-person programs, there are online programs; and we make our programs available to — as I mentioned – communities in terms of hospitals, community mental health centers. We have specific programs for colleges that weÉ since obviously that's a specific age population and we try to adapt our materials to that population; and for the college program we also include screening for alcohol since that is obviously an issue in the college-age population. We have specific programs for middle schools and high schools that really focus on the issue of suicide, suicide prevention — because in middle schools and high schools the issue of suicide is so critical that we believe that about 1500 young people from ages 15 to 19 commit suicide in any given year — or I think it's actually closer to 2,000. And it's important for anyÉ you know, when any young person commits suicide we want to do all that we can to try to reduce that, because it's a tragedy in the school, family and the community that has reverberations, not only for months but potentially for years. So our programs try to educate student body teachers, parents how to recognize signs of suicide and how to respond. We also have programs for the military in which we provide all of our materials to bases nationwide and in worldwide for all returning veterans and their dependents.

DR. RAHN BAILEY QUESTION:That's such an outstanding idea because in reality we recently recognized with excessive military engagement, that the process of what we do as mental health professionals changes.

DR. DOUGLAS JACOBS ANSWER:Right. And I should say that the goal of our program, whether it's in the military or in the general public, is to address the issue of stigma. When I started the program back in 1991, there was notÉ screening for mental disorders was not done; it was not thought to be possible. The National Institute of Mental Health had uncovered that depression was under-diagnosed or under-treated, and that we have health screening in a variety of otherÉ you know, that our medical colleagues do in terms of diabetes, hypertension, breast cancer, prostate cancer. And I began to question: why couldn't psychiatry do what our medical colleagues are doing. So I developed this model of depression screening which encompasses the basic principles of health screening in that it's relatively cost-effective, it's free, it's anonymous. And then when people get screened it doesn't give them a diagnosis, but it gives them an understanding as to whether or not they may be suffering from an illness such as depression that deserves further treatment. And part of the other issue that I mentioned in terms of stigma is to let the public know that, quote, Òa mental disorder, psychiatric disorder, depression is like any other medical illness.Ó It has specific signs and symptoms and available treatments.

DR. RAHN BAILEY QUESTION:I totally agree. I don't think we can say that enough whether we (unint.) otherwise. You just appoint an educational standpoint that just must be emphasized and reemphasized. And often I find myself — and we do; I'm down in Houston of speaking to persons who'll even reference. We finally got them to take a step out into (unint.) care — (unint.) or family of a loved-one — was a program very similar to this one. It was educational, it was fairly general, it was there to decrease stigma – just extend a welcoming hand, if you will, to those who are in need, you know, because of any (unint.) if you will of adversity and negative propaganda and stigmatization of having brain-related illnesses were reluctant to do so. So really I think this type program has a (unint.) opportunity (unint.) in these areas. I'd love, as we get ready (unint.), give you a chance to add any other additional points. I think we've hit all of the key items that I was aware of and that I wanted to ask you about. I was really interested in that point about the military and you, I thought, addressed that very well. Any other points or items that our audience should know? And when I looked, it actually gives your website address.

DR. DOUGLAS JACOBS ANSWER:Yeah. Well, the — and just to, again, emphasize the stigma — the organizations that we mentioned earlier – the advocacy organizations, such as Mental Health America or NAMI, their main emphasis is on reducing stigma because that that continues to be a problem today in America. The one program we didn't mention is that we do offer our programs in the work place which, again, is another area — since the majority of Americans are in the workforce — to encourage companies to acknowledge that depression exists. There have been some recent studies that demonstrate that early treatment for depression is not only in the best interest of the employee, but also of the employer in that it improves work performance, decreases absenteeism, et cetera. And, as I said, that program is primarily available online for the companies, and, again, it's free and anonymous for the employee and people who are working are given resources either through their company or in their local area about where they can get help.

DR. RAHN BAILEY QUESTION:I agree. I will comment aboutÉ you used the term ÒabsenteeismÓ, if it's an appropriate one. I think many of our audience will be very aware of that. Some may not be aware that now when you use the term ÒpresenteeismÓ (sic), particularly as it pertains to psychiatric illness or depression or emotional mood disorders often who actually go to work and (unint.) not able to function.

DR. DOUGLAS JACOBS ANSWER:That's an excellent point because sometimes just because someone's at work, they're notÉ you know, they feel this pressure to go to work and yet they're not functioning at the level that they know they can. And it can be demoralizing for them, for their co-workers, and it begins to further erode their abilities to perform; and so we encourage those people to get treatment. The otherÉ You know, I did mention briefly the military – and I only want to emphasize that because there's been a lot in the media about how difficult the war has been and that the military is doing a great deal to acknowledge the commitment of young people who have served their country and to provide, not only the resources — but, again, to acknowledge that mental disorders can occur in this age population, that the illness of what we call post traumatic stress disorder can occur as a consequence of being involved in the war; and early recognition and treatment of these disorders can reduce long-term consequences. So, againÉ And it's a positive program that the military is sponsoring. You know, the media sometimes is quick to focus on the negative aspects of the military's sort of caring for its service providers. We're here, this is clearly a positive program for military members — it's called the Mental Health Self-Assessment Program — they can go on a website 24/7, take a test and then they can find where they can get help either in their community or on their bases; and we certainly encourage families who listen to this program because they can also access this program.

DR. RAHN BAILEY QUESTION:This is outstanding. I just thank you so much, Dr. Jacobs, for sharing and reporting the information with us. This work is not only important but essential for all of us. I think we all owe quite a bit of gratitude to you (unint.) in psychiatry because what you're doing there in the Boston area and Virginia and Florida and Texas and California–there's people all over the country and all over the world, for that matter, who really need to have those barriers lessened and they can actually pursue and seek psychiatric care.

DR. DOUGLAS JACOBS ANSWER:Well, thank you very much; and, you know, we've had the support of such prominent organizations as the American Psychiatric Association. The joint mission of trying to reach out to those people who are suffering from mental disorders may not be aware of it and that treatment is out there and that accessing treatment is not an indication of weakness, but rather of strength because treatment can improve symptoms and can save lives and then that's really what we're about.

DR. RAHN BAILEY QUESTION:Excellent. Thank you very much.

DR. DOUGLAS JACOBS ANSWER:Okay, well, thank you.

DR. RAHN BAILEY QUESTION:Well, for the Depression is Real Coalition, I'm Ron Bailey. Please join us next time for another addition of the Down and Up Show on Depression is Real.org. AD: Thanks for listening to the Down and Up Show. For more information, log onto www.depressionisreal.org. You can find us there and get iTunes.