The development of a clinic for the management of depression and anxiety: the Depression and Anxiety Research and Treatment (DART) Clinical Program

Many community-based surveys have established the high prevalence of mood and anxiety disorders. The 12-month prevalence of anxiety and mood disorders in Australia recently documented in the National Mental Health and Wellbeing Survey is 9.7% and 5.8% respectively. These disorders have been shown to be chronic and disabling. There has been recent interest in the development of the World Health Organization Global Burden of Disease study which reported that the 'burden of psychiatric conditions has been heavily underestimated'. In developed nations as reported in 1996, mental disorders contributed 17% of the total burden of disease, with affective disorders accounting for 7.7% and anxiety disorders 2.3% to this figure. The high level of psychiatric comorbidity in patients with mood and anxiety disorders has also been well documented. The National Mental Health Policy developed in 1992 focussed the delivery of mental health services on a group of patients with 'serious mental illness'. In adult psychiatry, this group of patients was most commonly defined as patients with schizophrenia or bipolar affective disorder. The trend towards treating the severely mentally ill addressed the concerns of the government and the community to better manage this very disadvantaged group of patients with mental illness. However, this strategy has been at the expense of providing treatment to other groups of patients with mental illness who have also been shown to be disabled and are now disadvantaged by the current mental health system. For example, in Victoria, this led to a change in public mental health service delivery with patients with anxiety or depressive disorders rarely included in the caseload of a community mental health clinic. The Depression and Anxiety Research and Treatment (DART) Program, was developed by a group of senior academic clinicians concerned about the lack of treatment available for patients with mood and anxiety disorders. This paper will outline the development of the DART clinical program, which provided assessment and treatment of patients with depression and anxiety