Challenges associated with being an off-site depression care manager.

Within the context of depression care, the U.S. Department of Veterans Affairs (VA) has an ongoing depression care manager (DCM) training program. The VA has already trained approximately 50 DCMs and plans to continue DCM training to facilitate the integration of primary care and mental health care. This article provides an overview of the role of a DCM, challenges encountered by an off-site DCM, and strategies to address those challenges. Specifically, this article addresses the following challenges from the perspective of the DCM: suicidal patients, different agendas between patients and DCMs, feeling isolated, maintaining boundaries, building trust, learning to read between the lines, and dealing with hard-to-contact patients. Care management in the context of a distributed care team is becoming increasingly popular in health care systems.