The Kidney Citizen May 2016 - Page 12

12 the ki ney citizen Improving Mental Health Care of Kidney Disease Patients: A Call for Action By Molly Phillips, MPH, MSW, Barry Smith, MD, PhD, Pamela Hoyt-Hudson, BSN, RN, and Jennifer Melendez, BA, CHC, CHRC, CIP (all from The Rogosin Institute) The following article was submitted by the Rogosin Institute. It highlights their work to meet both the physical and emotional needs of their patients. Talk to your dialysis facility about the resources that may be available to you. In a recent conversation between a staff member at the Rogosin Institute and a dialysis patient in Brooklyn, the patient shared that at 37, she had been on dialysis for over 15 years after a diagnosis of nephrotic syndrome in her late teens. Years ago, a family member donated a kidney. However, after only two years, the transplant failed. In addition to telling the staffer about how much she was struggling to stabilize her blood pressure and how frustrated she was following multiple hospitalizations in the preceding two months, she shared that she had recently lost her uncle to cancer, that she had to move apartments and was unsure how she could afford the move, and that she was fighting with her mother, among other stressors. This patient’s experience is a perfect reminder that we cannot possibly expect End Stage Renal Disease (ESRD) patients to follow their complex healthcare plans if they are concerned about rent, have little social support, or have other life stressors beyond their dialysis care. As healthcare providers, we must do a better job at addressing the socio-economic needs of our patients by connecting them to resources and organizations that can help. We must also recognize the many factors that influence adherence to treatment and provide more comprehensive mental health care to our patients. We must enhance opportunities for communication and work with patients as partners. Depression, anxiety, and stress among dialysis patients are incredibly prevalent, and as providers, we can – and should – do more to support the whole person, including their mental and emotional health needs. Dialysis patients are not defined by dialysis or ESRD, but rather by everything that makes them unique human beings, just like all of us. Research suggests that over one third of hemodialysis patients experience clinical depression (Palmer et al, 2013), and around half of patients experience anxiety (Cukor, 2008 and Feroze, 2012). The Centers for Medicare and Medicaid Services recently acknowledged that depression is all too common and ignored among ESRD patients. With this in mind, this year, CMS is requiring dialysis units to screen patients for depression. But simply screening patients is not enough: we must have adequate follow-up plans in place for patients who need treatment and further support. In recognition of the need to better address the mental health needs of dialysis patients, in October 2015, the Jack J. Dreyfus Center for Health Action and Policy (CHAP) at The Rogosin Institute convened a Roundtable discussion with experts in the field of mental health, depression, and kidney disease entitled