October 10, 2016

Coordinated care lifts darkness of depression

“Talking to other patients, I realized I was struggling with my own depression,” Debbie Chagolla said. “I had taken on a lot of extra things in my life."

Debbie Chagolla’s job is to help people who are dealing with depression.

She guides people through a treatment plan designed to lift them out of the darkness of depression and back into the light of fully living life again.

Ironically, it took her awhile to realize that she needed the same kind of help herself.

Chagolla is a disease management technician for Kaiser Permanente, working in the health care provider’s depression care management program in Aurora, Colorado. She had been diagnosed with depression and been prescribed medication twice. Both times she stopped taking it after the first week because it wasn't working for her.

But when her brother-in-law died and Chagolla had to help care for her sister’s children, in addition to her own, she became so overwhelmed that she asked her primary care doctor to prescribe her an antidepressant again, and this time she decided to go through the depression care management program herself.

“Talking to other patients, I realized I was struggling with my own depression,” she said. “I had taken on a lot of extra things in my life. I was exhausted but I couldn’t sleep. I didn’t want to do things. I couldn’t get out with my kids and do activities we would normally do together. I gained weight. I went to work, but all I really wanted to do was lay in bed all day.”

Regular check-ins

In the program, Chagolla got the kind of support and guidance that can make all the difference in the treatment of depression. Depression Care Manager Cindy Pfluger, RN, initiated the series of check-in phone calls that are at the heart of the program.

In the first call, Pfluger spoke with Chagolla about the side effects she might experience from her medication and explained how the prescription was just part of a holistic approach to returning her to emotional well-being.

“When Debbie first came to me, she couldn’t sleep,” Pfluger said. “Her job was being affected. She had always taken pride in being able to multi-task, and she couldn’t do that. Like it often does, her depression had come on slowly, and I explained to her how treatment could slowly make her feel better.”

The pair talked on the phone in a scheduled series of weekly calls over the next few months. Early on, working with Chagolla’s primary care doctor, Pfluger recommended an adjustment to her medication dosage.

“Cindy helped me through those first weeks on medication and it made a huge difference,” Chagolla said. “Just having that support and someone monitoring you makes a huge difference. It’s so good to know that I have this number I can call and get help.”

Pfluger also assessed Chagolla’s progress by regularly administering the Patient Health Questionnaire (also called a PHQ-9), a best practice screening tool used by Kaiser Permanente and other care providers to identify the degree of depression. On the form, patients are asked to rate the severity of common symptoms, which helps track progress of treatment.

Integrated care for total health

In monitoring patients, depression care nurses work with physicians and other members of the care team to make sure patients who need other services — such as therapy or classes for coping with anxiety — get the care they need.

Kaiser Permanente’s integrated system encourages collaboration between mental health and primary medical care. With its mental health therapists, psychiatrists, primary care physicians, nurses and pharmacists coordinating care for their patients, the organization is well-positioned to lead the way in meeting the needs of the growing population of Americans in need of mental health care.

At Kaiser Permanente, the goal is always “total health,” emphasizing a person’s physical, mental and spiritual well-being. The depression care management program focuses as much on lifestyle as it does on medication to help patients get better.

As she does with all her patients, Pfluger helped Chagolla make lifestyle changes such as getting more social time with friends, eating better and getting outside to exercise. “Lifestyle changes are what will get you through it,” she said. “It’s connecting with people and taking better care of yourself. Exercise is really important because it releases endorphins that can help alleviate symptoms of depression.”

After a year as a patient in the Kaiser Permanente depression care program, Chagolla has “graduated” to a life that is much improved.

“It’s like a light switch went on,” she said. “I have started projects around the house. I am doing spontaneous things with my kids. It has made us closer as a family. They tell me I am so much better. You don’t really understand how dark the hole is until you get out of it.”

It is patients like Chagolla who inspire Pfluger every day. The fact that both women also serve together as care providers made this case extra special.

“It’s very rewarding work,” said Pfluger. “As patients get better, you can hear it in the tone of their voice. With Debbie, I got to experience it first-hand. When someone gets better, it means life is not just better for them but it’s also better for the people around them. When someone gets the breath of life back, it’s so satisfying to see that black cloud lift.”


October is National Depression and Mental Health Screening Awareness Month

This month is dedicated to raising awareness about the importance of screenings for depression and related mood and anxiety disorders.

According to the National Alliance on Mental Illness, an estimated 16 million American adults — almost 7 percent of the population — had at least one major depressive episode last year.

Primary care physicians at Kaiser Permanente are trained to look for signs of mental health needs when they are treating patients. They can perform screenings using a brief questionnaire that has proven effective in identifying mental health issues, and they work with patients in shared decision-making regarding further evaluation and treatment, which may include medication and referral to mental health clinicians within Kaiser Permanente. Increasingly, many of the organization’s primary care teams include mental health clinicians.

Kaiser Permanente is also teaming up with other organizations, including the National Alliance on Mental Illness, National Suicide Prevention Lifeline, Crisis Text Line and Mental Health America, to change the conversation around mental illness. The public health awareness effort, " Find Your Words," focuses on mental health and wellness with spots for TV and radio featuring lyrics that speak about depression in an honest and inspiring way. The “Find Your Words” website guides users to helpful resources within Kaiser Permanente and in the community.