Building a System of Perfect Depression Care in Behavioral Health

Background: Depression, a common, serious disorder, may result in suicide in up to 10% of afflicted persons. Methods: In 2001, the Division of Behavioral Health Services of the Henry Ford Health System (Detroit) launched an initiative to completely redesign depression care delivery using the Six Aims and the Ten Rules from the Institute of Medicine report Crossing the Quality Chasm. This Perfect Depression Care initiative, whose key goal was the elimination of suicide, entailed performance improvement activities in four domains-partnership with patients, clinical care (planned care model), access, and information flow. Results: The rate of suicide in the patient population decreased by 75% (p = .007), from similar to 89 per 100,000 at baseline (2000) to similar to 22 per 100,000 for the four-year follow-up interval (the average rate for 2002-2005). Discussion: This sustained reduction in suicide rate suggests that the process improvements implemented as part of the Perfect Depression Care initiative substantially improved the care of persons with depression. The initiative is the prototype for a comprehensive redesign of behavioral health care. Work is under way to perfect the care of persons with anxiety or psychotic disorders, and similar care systems are being developed for violence prevention and medication safety, with a particular focus on perfecting communication between providers. Pursuing perfection is no longer a project or initiative but a principle driving force embedded in the fabric of our care.