Integrated depression care (IDECA) project: investment amount of strengthening general medical practice with a dedicated mental health professional

Background: Depression in Belgium is the number one reason for disability-adjusted life years lost. Unmet care needs are plenty, partly caused by a lack of care integration. Integration of mental health services within primary care can be achieved through strengthening general medical practice with a dedicated mental health professional working across care lines. Estimating the direct budget impact of such a care model is pivotal for its sustainability.

Approach: The IDECA-project has been implemented in two Flemish regions and included the integration of two reference persons mental health (RPMH; case management function) into general medical practice who provide diagnostic support,  coordination, follow up care, and patient education. A mixed-method research - including focus groups, interviews, process evaluation, and surveys - evaluated the RPMH’s case mix, case load and budget impact.

Results: General practitioners (GPs) had to be stringent in referring patients to the RPMH: only 26% of possibly eligible patients received the offer to be referred to the RPMH, of which 76% accepted. One full-time equivalent RPMH had a yearly case load of 175 (77% female; average age 41; 54% at least moderately-severe depression score on PHQ-9). Implementing a dedicated mental health professional into Belgian general medical practice comes with a yearly investment cost of 120-135K€ per RPMH. Budget scenarios have been estimated based on the proportion of GPs who would like to set up a likewise collaboration with a RPMH.

Implications: A yearly budget impact of 16-18M€ for 132 RPHM’s or 63-71M€ for 529 RPHM’s would suffice to cover personnel costs, organization costs, and GPs’ incentive fee, if RPMH’s would collaborate with respectively 20 or 80% of the 11,240 Belgian GPs. This calculation does not yet take possible payback amounts into account.