As a former director of a community mental health center, Joan Blundall, MS, HCA, knows all too well what untreated depression can do.

“I've seen too many children who were unable to develop normally because of a parent who had an untreated condition of depression; I've seen too many marriages break up because there was a medical condition like depression that was treated too late or inadequately; I've seen too many people slip on the economic ladder because their work was impacted by depression; and I've seen too many people in nursing homes who entered prematurely because of their chronic conditions,” the mental health advocate recalls.

What she hasn't seen is a long-term plan of action to help rural communities deal with issues surrounding depression. “If we don't see services changed for the entire community — medical providers, the community at large, those who live with depression, etc. — we won't see our systems change,” she says. “There are too many one-shot attempts to try and deal with the problem. We have to look at how we get information about the treatment of depression to all levels of the community.”

Major depression causes more disability than any other disorder in the United States and is recognized as a major public health problem, according to Blundall. In Iowa, the problem of treating major depression is compounded because of medical and mental health provider shortages in many parts of Iowa.

In 2004, with a grant from The Wellmark Foundation, Blundall, now executive director of Higher Plain, Inc., in West Branch, Iowa, and Carol Hodne, PhD, developed “Beyond Depression:Tools for Collaboration in Cedar County, Iowa.” A $75,723 grant from The Wellmark Foundation in 2005 allowed Higher Plain, Inc., to expand its rural depression project statewide to include urban issues and targeted groups. The set of four toolkits focuses on three different audiences: medical providers, those who live with depression, and the community. There is also a desk reference for medical providers. The toolkits were developed with input from the medical community, the general community, and consumers and their families. Higher Plain, Inc., a non-profit corporation, is providing administrative oversight and consultation.

Blundall says extensive peer review led to the development of the separate toolkits. “We listened really hard to what people wanted and realized the design of the toolkits needed to be different. We thought we could just compile things differently, but that wasn’t the case. Consumers needed more of a workbook. Medical providers wanted a nuts-and-bolts desk reference. We also had to compile the research to back up the toolkit.”

Higher Plain staff worked with the MacArthur Foundation's Initiative on Depression and Primary Care to incorporate its best-practice toolkits into the local medical provider reference guides. Blundall is receiving calls from professionals around the country who are using the toolkits in different ways, but it is the feedback she is hearing locally that inspires her. She's heard from members of the clergy, who tell her how the material has allowed them to incorporate the topic into their sermons. Consumers have told her how they have been able to work with their depressed family members and get them to seek treatment.

For the mental health advocate, these toolkits are just a beginning. “It's one step on the pathway,” Blundall explains. “I've been amazed by how much of a need there is out in the community and the people we have been working with have asked what's next.”

And, that's what Blundall is working on now. She cites caregiver stress, working on ways to keep people from prematurely entering nursing homes, and even health literacy issues, such as developing toolkits for the visually impaired, as areas that can be improved. “I see these initial toolkits as the beginning of having the basic information for the future that allows us to then spring forth and determine how we respond to those in need.”

The toolkits are available free of charge to providers and consumers.They may be downloaded at www.higherplain.org.