12.6.2 What you do next
Treatment of depression usually involves a combination of self-help, drugs and specialised treatments. Specialised treatment refers to treatment provided by specialist mental health services. But most depression does not require specialised treatment and there is a lot that you can do at the community level.
In most cases of mild depression you need to just regularly monitor how the person is doing. You need to monitor the person for any worsening of symptoms, and for improvement in the problems that may have led to the development of the mild depression. You especially need to check for deterioration in the level of self-care and for any indications of risk of self-harm or harm towards others. Tell the person that if they feel worse, they should let you know. In Section 12.9.2 we will discuss some practical advice you may give to people with depression.
When mild depression becomes a persistent problem (a depression lasting for two years or longer), you should refer the person to the next higher level of the health system. If the illness becomes more severe or you identify risk of self-harm or harm to others, you should also refer the person. Another reason for referring someone with mild depression is when you suspect their depression may be related to a physical illness such as diabetes, hypertension or other life-threatening condition.
Moderate or severe depression
Individuals with moderate or severe depression require evaluation at a higher health facility, so you should refer them. Between visits to the higher health facility you should continue to monitor the patients in your community, similarly to what you would do with someone with mild depression.