[#WHD2017 Blog Series] Inspiring Innovations: European Alliance Against Depression

This blog is part of our series celebrating World Health Day, this year themed “Depression: Let's Talk.” Hear what our community of innovators has to say about the ideas behind their Inspiring Innovations, and how they address depression across the globe.

In this instalment, the team behind the European Alliance Against Depression discusses their approach to preventing suicidal behaviour and improving the care of patients with depression.

Tell us about your country’s context and the circumstances that inspired your innovation.

The European Alliance Against Depression (EAAD) 4-level model was initially piloted in 2001 in Nuremberg (Germany), a city of about 500.000 inhabitants. Underdiagnosis and undertreatment of depression, in part due to stigmatizing attitudes and a lack of help-seeking, were some of the main barriers that we faced back then - and still are. Studies indicate that approximately half of the general public is convinced that people with depression are weak, responsible for their own condition and unpredictable; and nearly a quarter considers them to be dangerous.

Even though suicide rates have declined in Germany since the 1980s, they are still exceeding deaths caused by car accidents, AIDS, and drugs taken together.

When piloting EAAD, we wanted to overcome these barriers by building a sustainable regional network, training mental health professionals and stakeholders, launching a media campaign, and supporting patients to enhance knowledge about depression and trigger help-seeking while at the same time preventing suicidal behaviour.

The Nuremberg pilot was so successful in reducing suicide (a 24% reduction of suicidal acts compared to a baseline year and a control region) that it has been implemented in over 80 regions throughout Germany now.

When the EAAD was first introduced to the European context in 2004, it faced different country-specific factors such as different mental health care systems and care provision as well as differences in public attitudes and concerns about antidepressants and psychotherapy for depression.

Therefore, the EAAD approach is flexible and varies by region or in different communities (see Figure 1). In support of such flexibility, the World Health Organization (2014) recommends national suicide prevention strategies that allow communities to focus on their own specific needs. The EAAD 4-level intervention can be adapted to the local context to include the measures most needed and feasible to a specific region.

What aspect of your project are you most excited about? How is the project innovative or unique?

We are most excited about setting foot into the field of E-mental-Health by disseminating our iFightDepression® online self-management tool for patients with milder forms of depression to countries all over Europe! Our CBT-based tool is free of cost for patients, guided by mental health care professionals and currently available for patients in Germany, Hungary, Greece, Italy, Estonia, Spain and soon in Norway, Albania, and Kosovo! It will help in bridging waiting times for psychotherapy and as an additional asset to depression treatment.

With 24 member countries to date, EAAD certainly connects different experts and stakeholders around the globe in a learning network, enabling them to share experiences and research findings on depression and suicide prevention.

Have you noticed an impact ‘on the ground’? What is the best feedback you have received (from service users, team members, or otherwise)?

It is not just a framework for mental health clinicians and professionals, rather provides access to world’s best practice, tools and resources for communities to actively participate in providing mental health care for their families and neighbourhoods.

- Dr. Daniel Rock, Western Australian Primary Health Alliance, 2017

EAAD is a robust and proven framework that can guide and shape a community’s response to destigmatising mental health and reducing suicidal acts.

- Former Chief of the Defence Force, Air Chief Marshal Sir Angus Houston, Western Australia, 2017

We have certainly noticed an impact on suicide rates in Germany, Hungary, and Portugal and a change towards more positive attitudes on depression and help-seeking due to community facilitator trainings and our public relations campaign. Furthermore, we noticed a positive change towards more appropriate media reporting on depression and suicidal behaviour thanks to our media guides. For an overview of evaluation results and impacts, please see the following link.

Last but not least, we are proud to have been awarded the first European Health Forum Award in 2007 and to be mentioned as an example of a successful concept to prevent suicide (Green Paper on Mental Health). More recently, we have been mentioned as an effective, multicomponent intervention in the Suicide Prevention Report of the WHO (2014).

What’s next?

We have started to introduce our model and resources to low and middle income countries in Eastern Europe and even overseas (e.g. Australia & USA)! We are also now involved in the promising field of implementation research.

By mid-2017, we will relaunch our iFightDepression awareness webpage (currently available in 13 languages) to make it more user friendly and ready for more language versions in the future! This will help us to adapt our online resources for migrants and refugees also (e.g. with an Arabic version of the website and self-management tool).

Keep yourself updated on more EAAD projects via our News Feed and follow our recently launched Twitter Account!

What is the one message about depression you want people to take away from your innovation?

Depression can be treated!

When trying to improve the care for depressed patients and to prevent suicidal behaviour, it is essential to include all levels of care providers, the broad public, media, different stakeholders as well as patients and relatives simultaneously to make it a success!

To read more about the Innovation, visit the case study page.

To see the other blogs in this series, visit our [#WHD2017 Blog Series].