Direct-Dialing: A Tonic for Depression

DIRECT — the Depression Information Resource and Education Centre (Toll-Free) — is a non-profit service designed to provide information and education about depression to the public and healthcare professionals. The service couldn’t be much easier or handier: The only high-tech equipment required to log on is a touch-tone telephone (though there’s also an Internet address for those who simply must use their computer link).

DIRECT is actually two services, a phone line for physicians that’s designed as a clinical reference system, and a public service to provide information about depression and bipolar (manic-depressive) disorders. When DIRECT was launched by McMaster University in Hamilton, Ont., in May 1996 (with funding from five pharmaceutical companies), the 1-888 line for physicians was available nationwide, but the public line was only accessible in Ontario. In October, the public line goes national on a trial basis — with luck, just ahead of National Mental Illness Awareness Week (Oct. 12-18).

DIRECT is the brainchild of Dr. Russell Joffe, Dean of the Faculty of Health Sciences at McMaster, and Dr. Anthony Levitt, head of the mood disorders program at Sunnybrook Heth Sciences Centre in Toronto. Both receive calls on a regular basis from the public and from physicians seeking information about and treatment advice for depression, so they knew there was an information gap that needed to be filled.

“Mental health agencies and healthcare professionals have been increasingly called upon to provide expert advice and appropriate treatment options for people with mood disorders,” they say. “At the same time, information about the disorder and effective treatment choices are expanding.”

DIRECT was their answer to those changes: An attempt to improve the rate of early, accurate diagnosis and effective treatment for people with mood disorders and, at the same time, provide an information resource to help people suffering from depression and their families learn about the illness and its treatment. With more than three hours of information neatly organized on each line, DIRECT is a terrific resource.

What it’s not is a crisis line; it doesn’t provide physician referrals or comment on individual cases; nor does it endorse any individual product or treatment used with depressive disorders. It’s simply a way of providing people with accurate answers to their questions about depressive disorders in a straightforward, useful and easily accessible way. As the service itself says, “If you need emergency help, please contact your family physician, go to your nearest hospital emergency room or, if it is available in your area, call 911.”

Both Levitt and Josse are keenly aware there’s still a stigma attached to depression, so the first thing they wanted people to understand is that depression is a medical illness — indeed, an important illness that needs attention but far too rarely receives it. They also wanted people to know that, these days, there’s a whole range of effective treatment strategies available for depression. DIRECT is a way of providing people with enough information and education so that they can understand what’s going on with their depression and its treatment.

As DIRECT coordinator Michael Quinn points out, “studies have shown that, if you provide patients with the right kind of information and education so that they’re aware of what’s going on and why things are occurring as they are, they’re more likely to accept the diagnosis and to then follow the treatment plan. While there are always cases that are just really tough to treat, for the most part depression can be quite responsive to treatment.”

The question is, are people who are depressed likely to use such a service? So far, the answer appears to be a resounding yes. In the first year it was operational, DIRECT received some 28,000 calls from people who generated about 240,000 minutes — that’s 4,000 hours — of “on-air” time, though a good number of callers weren’t able to get through because the demand was so high. (DIRECT has since upgraded its lines to accommodate more calls.) Many of the callers who did get through answered the self-assessment questionnaire, a series of 10 questions to which you answer yes or no by hitting buttons on the phone. You’re asked to enter your age and sex, but it’s totally anonymous. From the results, Quinn says, McMaster has determined “that at least 70 to 80 per cent of the 4,500 people who took the test had or have had clinical depression.”

Obviously there are people so seriously depressed they won’t be able to bring themselves to use the service, but those who can appear to be benefitting from it. Many people, for example, find DIRECT useful after a visit to their doctor’s office, as a way of clarifying or expanding their understanding of what the doctor may have said or about a medication he or she prescribed. “Then they’ll go back,” Quinn says, “and they’ll talk to their physician about what they heard.”

In some families, it’s the spouse of the person in treatment — who may not want to talk about their depression or their treatment — who uses the service, perhaps to gain a better understanding of what their role should be in their spouse’s care. A man or woman will come home, Quinn says, “and the spouse asks, ‘What did the doctor say? Are you going to be better?’ That puts a lot of pressure on the person who’s depressed. What we’re trying to do by providing this tool is provide assistance for the spouse who may not be within the care environment [a doctor’s office, clinic or hospital], to help them understand more about what’s going on.”

And, of course, it’s not just patients and their families who are calling; doctors are using the service, too. Many of them call the physician line to increase their own understanding, so they can treat their patients more effectively. According to Quinn, many physicians also listen to the public line with their patients; using a speaker phone, they dial up an appropriate segment, and the doctor and patient listen in. “It’s an opportunity for the patient and his or her doctor to discuss what they’ve heard,” Quinn says. “People tell us it’s a very useful clinical tool.

“We see our service as complementary. In other words, we don’t want to replace the interaction that patients have with physicians or support groups and networks of support. What we’re trying to do is provide a source of information, and because we’re delivering it at home through phone lines, as opposed to the Internet, we feel it’s much more accessible, and people can listen to it when they’re ready to.”

How to DIRECT-Dial

Dialling DIRECT is easy and anonymous. Just dial 1-888-557-5051, extension 8000, for the public line (the physician line is 1-888-557-5050, extension 800), then choose your path through the sections and subsections by pushing the appropriate buttons on your phone. You can even ask a question by dialling zero; during business hours (weekdays from 10 a.m. to 6 p.m.), an information officer will either direct you to the right location on the DIRECT hierarchy or relay your question to the DIRECT offices, which will try to find the answer to your question (by consulting the experts) or refer you directly to a suitable authority — via the phone number of a pharmaceutical company, for example, if it’s a question about drug interactions. If you’re calling after hours or, if the operator’s not available, you can leave a message, and they will return your call as soon as possible.

If questions are too specific, DIRECT can’t answer them; the best they can do, says program coordinator Michael Quinn, is “frame answers in a population-based response. That’s one of the limitations. We can’t really respond specifically on a case-by-case basis.” With questions that are too specific, they try to suggest general response strategies or recommend specific DIRECT sections that could help the caller resolve the question. If that isn’t enough, Quinn or the operator will recommend the caller talk to his or her doctor or ask for a referral to a psychologist, psychiatrist, mental health organization, hospital, etc. — without a specific recommendation to see any particular doctor or service. Again, they can’t.

The material contained in DIRECT was written by Drs. Joffe and Levitt and reviewed for accuracy by a medical panel made up of what Quinn calls “very prominent people in mood disorders across Canada.” In addition, DIRECT draws on its advisory board, made up of a cross-section of people in the community, for advice about the service. Some board members have had mood disorders themselves; some have worked with people who have mood disorders; some are simply ordinary people who want to help.

The result of all this input is a clear, well-organized and truly useful resource. DIRECT is organized into five sections: Recognizing Depression and Manic Depression; Detailed Information on Depression; Coping With Depression and Manic Depression; Strategies For Getting Help; and Specific Drug Information.

• In Section 1, you can find out whether you are now or have ever had an episode of depression or manic depression by answering a questionnaire; there’s also information on how to recognize the signs and symptoms of depression in others.

• Section 2 describes the different types of depression and various treatment methods, including medications; electroconvulsive, or shock therapy; light therapy; and psychotherapy. There’s also information on the ways depression can affect men and women at different stages of their lives, as well as tips on how to deal with depression and grief, substance abuse, panic attacks and other medical problems.

You can also go directly to any section by “speed-dialling”: For example, to listen to DIRECT’s detailed drug information on Prozac, dial up DIRECT, enter the extension number, then simply dial 51211, and you’re there. Or for information about cognitive behaviour therapy, dial 22212.

DIRECT offers a range of other services as well, including education materials, a list of depression resources, a speakers’ bureau, and help with references and research findings. For more information or to be added to DIRECT’s mailing list; to add your service’s name to the Ontario Resource Directory for Educational Information; or, to offer feedback on the service, call 1-905-575-6013. You can also write to DIRECT at Faculty of Health Sciences, McMaster University, Hamilton, ON. L8N 3Z5. The FAX number is 1-905-575-6054. DIRECT’s website is at http://www-fhs.mcmaster.ca/direct Send e-mail to [email protected]