The purpose of this study is to test the effectiveness of Open Door (previously known as the
Treatment Initiation Program [TIP]), a brief psychosocial intervention to address the
psychological barriers to care and improve the use of mental health services by depressed
community elderly. The intervention is designed to help the older adult identify the
barriers, problem-solve to find solutions and mobilize the motivation to seek help. Open
Door was developed to work collaboratively with an older adult who is depressed to improve
access and adherence to mental health treatment.
The primary aim of this research study did not change from the original application; it is
to conduct a randomized controlled trial of the effectiveness of a brief, psychosocial
intervention on engagement in mental health care among homebound depressed older adults.
Engagement is defined as accepting a referral and attending a visit with a provider who
could provide traditional mental health care (medication or psychotherapy). The
intervention, now called Open Door, 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, this
intervention 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 Open Door 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, Open Door will be associated with reduced
depressive symptoms by empowering the older adult to initiate care for him/herself.
- Age 60 years and older
- Endorse depressive symptoms
- 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