Increasing Use of Mental Health Services

The goal of this study is to conduct a randomized controlled trial of the impact of a brief,
psychosocial intervention -- the Treatment Initiation Program (TIP) -- on access to care,
defined as engagement (attending two sessions with a mental health provider), among
depressed community dwelling older adults participating in a home delivered meal program.
The Treatment Initiation Program (TIP) was developed to work collaboratively with an older
adult who has depressive symptoms to address the barriers to care with the aim of helping
them consider a referral and engage in mental health care. In prior research TIP has been
found to improve treatment participation, reduce depressive symptoms and increase adherence
to antidepressant therapy among depressed older adults in primary care and outpatient
psychiatric settings. We propose that TIP will improve the access to mental health care by
reducing psychological barriers, providing education about care, and managing the
resignation associated with the symptoms of depression among community dwelling depressed
elders. Additionally, we believe that despite the heterogeneity of mental health care that
may be received TIP will be associated with reduced depressive symptoms by empowering the
older adult to initiate care for him/herself.

Inclusion Criteria:

- Age 60 years and older

- Homebound

- Endorse depressive symptoms

Exclusion Criteria:

- Presence of significant alcohol or substance abuse or psychotic disorder

- High suicide risk, i.e. intent or plan to attempt suicide

- Cognitive impairment

- Inability to speak English

- Aphasia interfering with communication.

- Current use of antidepressants or psychotherapy