HLM: Are the screenings expensive or do they require significant time or resources?
ID: The screening cost in and of itself requires a little bit of extra labor on the part of nurses, but our experience here and in other locations is that nurses are readily able to integrate this.
It doesn't impact their work flows too much. Of course, more and more quality demands are placed upon nurses and we are very sensitive to that. But the nurses here really feel that this is a sufficiently important aspect of healthcare to make it a priority and to involve themselves in the screening.
The costly thing is actually referring patients and having them get treatment for their depression. That is a cost that ultimately patients and their insurers bear. What the literature shows is that it is even costlier not to address depression.
HLM: Many providers across the nation have problems accessing behavioral health services. Why bother screening patients if you can't get them the help they need?
ID: It should be the healthcare professionals' role first and foremost to determine what is wrong with a patient, to be able to diagnose them and refer them to the services that the patient needs in order to get better.
As a society we have a different problem, which is how do we finance the things that we know to be helpful to patients? What we are recognizing now is… that in the long-term some of the interventions that are simple and benign can be helpful in producing long-term gains for patients in reducing costs whereas in the short term it can be hard to recognize those values.
So, the closure of a lot of mental health services is a function of the fact that those services don't reimburse very well because our field and our society haven't done a very good job of recognizing the value of those services.