Commentary

In response to the high unmet need for mental health services, innovative interventions for “real world” treatment delivery systems now are being tested. These innovations adapt traditional counselling/psychotherapy and medication management approaches for use in less traditional delivery systems, such as telephone and internet based interventions for managing depression. Care delivered at a distance is often included within a broader programme of integrated primary health care for physical and mental health conditions.¹ These innovations show promise for improving the access and quality of depression care, with results most often equivalent to or better than usual care.^2,3

The study by Simon et al showed that use of care managers to deliver psychotherapy and care management by telephone can improve clinical outcomes and patient satisfaction. However, the study findings are limited by fairly low generalisability. The sample, consisting mostly of Caucasian women, was drawn from a prepaid health plan in Seattle, Washington, and differs demographically and culturally from other areas in the US and other countries. The prepaid health plan differs from the US fee for service system and the healthcare systems of other countries in structure and process. The intervention was delivered by specially trained care managers, a resource that often is not available within most primary healthcare settings.

Given the limited generalisability, the feasibility, acceptability, and effectiveness of this promising telephone programme will need to be tested in populations, settings, and health systems that differ in key ways from the reported study.