In the National Guidelines for Care of Depression and Anxiety Disorders 2010, the National Board of Health and Welfare highlights recommendations on screening, an effective care and intervention as well as diagnosis and treatment.
The guidelines also include recommendations on different treatments for children and young people and adults respectively. The object of these is to promote a range of care alternatives that include several effective treatments and that are offered uniformly throughout Sweden. In connection with the section on treatment, the National Board of Health and Welfare presents recommendations on what Health and Medical Care should especially take into account as regards medication treatment for older persons. Finally, the National Board of Health and Welfare highlights recommendations relating to suicide and suicidal conditions.
Central recommendations that entail financial and organisational consequences
The National Board of Health and Welfare considers that the recommendations concerning effective care and treatment within front-line care (e.g. primary care) or a selection of several effective treatment possibilities through the entire care chain are central prerequisites to enable these guidelines as a whole to deliver the desired results. In order to achieve the recommendation of being able to offer effective treatment options Health and Medical Care need to increase access to psychological treatment, primarily CBT.
The National Board of Health and Welfare considers that the greatest consequences of the recommendations presented in this document will be seen in terms of an effective care and an increased range of psychological treatment. The consequences will be both financial and organisational since they require changes in the organisational structure of Health and Medical Care and investments in human resources and competence.
Nevertheless, it is difficult, on the basis of a national perspective, to exactly estimate the economic and organisational consequences, primarily due to the fact that sufficient knowledge is lacking of prevailing practice and how the availability of personnel with sufficient competence works out in different parts of Sweden.
Effective care and treatment within front line care
The recommendation relating to an effective care and treatment for those seeking medical care within front line care includes several components that make demands on resources as well as on the organisation of the care to enable it to meet the needs of the patient group. The National Board of Health and Welfare adjudges the following components to be central in delivering care and treatment in front-line care:
- initial assessment with high level of accessibility
- good continuity during the entire care process, which includes interaction between primary care and psychiatric services
- interventions with integrated care inputs, adapted to individual needs and designed on the basis of the principles for step-by-step care.
In order for the care inputs to have the intended effect the following are required
- access to human resources with adequate competence
- a care structure that promotes an effective care and treatment
- access to consultation inputs in front-line care from Child and Adolescent Psychiatry and Adult Psychiatry
- possibility of follow-up and evaluation of treatment.
It is difficult to estimate the costs for the implementation of an effective care and treatment, since, on the one hand, what is involved is the organisation as a whole and its effectiveness and, on the other hand, access to personnel and the requisite competencies. Moreover, the development has not been uniform throughout Sweden. The National Board of Health and Welfare is, however, aware that these recommendations are resource-intensive, in particular in the short term. In the slightly longer term, however, the National Board of Health and Welfare sees a more effective care within Health and Medical leading to persons with depression and anxiety disorders being discovered at an earlier stage. Therewith diagnosis can be made and effective treatment introduced. In the longer term this results in less suffering for the individual and lower production losses for society as a whole.
Access to psychological treatment with CBT
The National Board of Health and Welfare has ranked psychological treatment, above all CBT, highly in the case of principle all mild and moderately serious states of depression and anxiety disorders. The main reason for this is that CBT has a good to very good effect on symptoms and functional capacity, both in the short and long term.
The National Board of Health and Welfare is aware that there is a major shortage of personnel with adequate competence within these areas. The recommendations demand that every county council (landsting) and region make an analysis of the current situation in respect of access to personnel with the right competence and how effective treatments are designed. On this basis, it is then possible to take a view as to the rate that it is possible to implement the recommendations on CBT.
Lack of data sources complicates follow-up
The National Board of Health and Welfare has developed 18 indicators for the follow-up of care for persons with depression and anxiety disorders. Of these, it is possible to monitor 9 through existing health data registers at the National Board of Health and Welfare.
One major problem within this area is that, at the present time, there is a shortage of data sources, especially within primary care. This means that it is still not possible to follow up 9 of these continuously at the national level. This will therefore require a continuing development at the local, regional and national level.