The story looks at an attempt by the Henry Ford Health System in Detroit, Mich., to eliminate suicide in its patients by taking a proactive approach to identifying and treating depression. The program, which was launched in 2001, is associated with a significant reduction in the suicide rate among its patients, even as suicide rates have gone up nationally.
The story is a richly told exploration of the program and its impact. And the storytelling substantively addresses the majority of our criteria. The major hole in this piece is that it doesn’t explore alternate explanations for the drop in suicides in this health system that might not have had anything to do with depression care. Inclusion of an independent perspective might have helped identify some of those reasons.
Suicide is a tragedy. In addition to taking the life of an individual, it can have profound and lasting impacts on friends and family who have lost a loved one to suicide. According to the CDC, the suicide rate in the U.S. was 12.6 per 100,000 people in 2013 — that’s more than 41,000 per year. And suicide is also a significant financial burden, with an estimated economic cost of $44.6 billion per year in the U.S. An institutional treatment strategy that could save lives and reduce the economic impact of suicide is worth covering.
At issue in the story is the health system’s so-called “perfect depression care,” which incorporates depression screening into primary care. Patients deemed to have, or be at risk of, depression are then given appropriate treatment. It’s difficult to pin a specific cost to this. The matter is further complicated by the fact that treating depression can also save money by driving down costs related to associated health problems. However, the story notes that Centerstone — a separate health system that has adopted the Henry Ford Health System’s model for a smaller cohort of patients — did do a cost/benefit analysis and found that it resulted in savings of more than $400,000 per year. While we’ll award a Satisfactory, we think there was a muddling here of Henry Ford’s global screening strategy with the intense care provision in the Centerstone model. It is not appropriate to apply the cost analysis of the latter to the former. In addition, it can be argued that screening every patient at every visit it wasteful. The story reads/sounds somewhat like a paean to doing as much as you can and adopting a kitchen-sink approach rather than a carefully honed and efficient one.
The story notes that the Henry Ford Health System currently has a suicide rate of 20 per 100,000 among patients with mental health and/or substance abuse problems, which is 80 percent lower than than it had been when the “perfect depression care” was launched in 2001. It also notes that the overall suicide rate for system patients is five per 100,000 — which is significantly lower than the national average of 12.6 per 100,000. It would have been good if the story had simply given the starting suicide rate among patients with mental health and/or substance abuse problems in 2001 (according to Henry Ford it was apparently 89 per 100,000), rather than asking readers to do the math.
This story looks at an overarching strategy for identifying and treating depression; screening patients to identify those at risk and then pursuing “appropriate care.” While individual drugs or other treatment options can have potentially adverse side-effects, the story does not attempt to evaluate specific courses of treatment. For that reason, exploring the potential harms associated with individual treatment options doesn’t seem relevant in this case.
The story tells readers (or listeners) that the Henry Ford Health System has 200,000 patients, and that Centerstone has implemented a similar strategy for “nearly 200 patients who’d already made a suicide attempt.” However, it’s not clear how or if the benefits of “perfect depression care” have fluctuated over time, whether there are particular groups that have benefited more (or less) from the approach, or how effective the approach has been in other systems where it’s been adopted.
The story does cite an epidemiologist who evaluated the outcomes at Henry Ford, and it would have been great if it could have dug into the details just a bit more. For example, we found a 2013 American Journal of Managed Care report about the program. Looking at that report shows that that denominator for these suicide rates (the total number of people who are counted as potentially committing suicide) represents all those with contact with the Ford behavioral health system. This has very likely changed over time as services expanded. Also what diagnoses were represented matter. The big issue is that a significant reduction in this health system might be regression toward the mean (where extreme rates tend to revert to more normal rates) and also the removal (by death) of the highest-risk patients in their rather small cohort — it is not surprising that the rate declines when successful suicide removes those at highest risk from the cohort.
No disease mongering here.
The story doesn’t include input from experts outside of the Henry Ford Health System. The story would have been stronger if third-party experts in mental health or epidemiology had been able to provide some critical context on how effective the “perfect depression care” approach has been.
The alternative to “perfect depression care” would seem to be the absence of a formalized requirement for mental health screening to be incorporated into primary care. The story compares perfect depression care to standard care, which would appear to be the primary alternative. The story also implies that the ‘contract not to commit suicide’ is an alternative and mentions that safety plans are included in the Henry Ford approach.
The story notes that “perfect depression care” has been either adapted or adopted by other health systems, and names two of them. It also says that health insurers and other health systems have expressed an interest in the approach. In short, the approach is not yet in widespread use, but may eventually be adopted in additional areas. Given that the story can’t be expected to incorporate a list of every health system currently using the approach, this earns a Satisfactory.
The story is very clear that Henry Ford Health System took a novel approach to addressing mental health in its patients with the particular goal of eliminating suicide.
The story does not appear to be based on a news release. (The most recent news release we could find on the Henry Ford Health System program dates back to 2010.)