There are two components to the Renfrewshire programme:
 

• a clinical service available to patients by GP referral from participating practices
   
• a "public involvement" programme which includes a number of public health interventions in Renfrewshire, as well as making the material on this website available to everyone in Scotland.

The clinical service

There has been widespread concern about a near-trebling in antidepressant prescriptions in Scotland over the last decade, despite little evidence of a change in the incidence or prevalence of depression itself.

There is good evidence to suggest that many people with mild depression are prescribed antidepressants, even though these medicines show little or no efficacy for mild depression and adjustment disorder. (See recent NICE guidance for more information). There is a perception that part of this prescribing practice reflects a lack of viable alternatives for GPs, faced with a depressed and distressed patient in their surgery.

This problem of potential "overtreatment" of mild depression probably co-exists with potential "undertreatment" of moderate to severe depression. Many people with moderate or severe depression are not prescribed antidepressants, or do not take comply with treatment in a way that would help them get most benefit from these drugs. As few as 50% of people repeat a prescription after the first month, and only about 20% of people complete the recommended "course" of antidepressants at six months.

Doing Well responded to this situation in two ways. Firstly, we aim to improve the assessment of depression severity in order to support clinical decisions not to prescribe for mild depression, stress and adjustment problems. Secondly, we aim to support people with moderate to severe depression to take antidepressants in a way that maximises the benefit of these drugs.

The clinical service receives electronic referrals from GPs that include a PHQ score for all patients. People with a score less than 15 (out of 27) are seen by a "self-help support worker", a psychology assistant who introduces relevant self-help material, and reviews progress over 3-5 contacts (including phone and email).

People scoring 15 or above on the PHQ are referred to a "primary care liaison worker"- a clinician with specialist mental health experience, who can work with self-help, brief psychological therapies and also provide advice and support in choosing and taking antidepressants. Contacts with liaison workers are typically a bit longer than with the self-help worker, though the average duration of treatment for both workers is relatively short overall- about two and a half hours.

Participating GP practices in Renfrewshire as of March 2006 are:

• Dr MacLaren, Houston & Bridge of Weir
• Dr Borthwick and Partners, 24 Quarry Street, Johnstone
• Dr Singh and Partners, Johnstone Health Centre
• Dr Nijjar, Bridgewater Medical Centre, Erskine

• Dr Masterton & Partners, Bishopton Health Centre

• Dr Griffiths & Partners, Erskine Clinic

• Dr O'Kane & Partners, Riverview Medical Centre, Johnstone 

• Dr Tabony & Partners, Mains Medical Centre, Erskine

• Dr Anderson and Partners, Renfrew Health Centre
• Dr Dunlop & Partners, Linwood Health Centre

• Dr Waterston & Partners, Lochwinnoch

• Dr Khanna, 22 Quarry Street, Johnstone

• Dr Wright & Partners, Ravenswood GP Surgery, Johnstone

• Dr Cassidy & Partners, Riverview Medical Centre, Johnstone

Public Involvement

Depression is too big a public health problem to be addressed at the level of the individual consultation alone. This website is part of an effort to improve awareness, information and choice for people with depression, as well as friends and family who would like to support them.

We aim to promote self-assessment of depression using the PHQ, encourage the use of non-drug alternatives to depression treatment for people with mild depression, and to improve understanding of the uses and adverse effects of antidepressants.

Although severe depression almost always requires antidepressant treatment, (with or without therapy of some kind), mild depression requires a much more flexible response.  "Programmed care" of various kinds for mild depression risks being too reductive, since there isn't a single intervention that will suit everyone.

We therefore think that it is better to allow people to find a response that best suits their needs.  Rather than impose one "solution", we aim to allow people to choose one of more from a range of options- this website is part of that effort.

As many as 80% of people with mild depression will recover within 6-8 weeks without any professional intervention at all. We think that this recovery can be supported and sustained by access to self-help, information and practical help such as "bibliotherapy" and exercise. The Public Involvement programme seeks to help this, while also improving access to professional help for those that need it.

"Knowing your PHQ is as important as knowing your weight."

"I knew I couldn't go on, because I was on a downward spiral."