Issue link: https://tmcpulse.uberflip.com/i/425954
t m c » p u l s e | d e c e m b e r 2 0 1 4 17 mental health professionals to provide essential information about the nature and treatment of mental illnesses. Advocacy groups are now in partner- ship with mental health professionals in generating resources to support research, clinical services, and fighting stigma on every front. They proclaim unabashedly, 'Yes, people in my family have mental illnesses; Yes, I have suffered from depression; Yes, I have abused substances. This condition is a brain disorder which tragically affects me and my family; and I am not a crimi- nal nor am I ashamed of it.' Psychiatrists are now sharing information with our patients and having them as informed as we are in all elements of their care. This did not happen in the past. If you read 'Fatal Pauses,' you will get a sense of how a modern psychiatrist works in partner- ship with his patients and their families in exploring and solving mysteries associated with mental disorders. Each holds vital clues and informa- tion requisite to solving the problems, which can't be solved by keeping either 'side' in the dark. So the participation of patients in their own care in psychiatry is a major important advance, and that includes patients' families and their communities. Our field now embraces a bio- psycho-social-spiritual approach to understanding and helping people with mental illnesses. Each of these aspects must be integrated in care and addressed to have good therapeutic outcomes. We commonly combine treatments—cognitive behavioral ther- apy with medications, for example—and do not embrace a reductionistic, single theoretical model. Nonetheless, it is important to recognize that the somatic organ of all behavioral disorders is the brain. Just like the organ of a nephrol- ogist is the kidney, and the organ of a cardiologist is the heart, the organ of a psychiatrist and other mental health professionals is the brain. We must know as much as we can about the role of the brain in every behav- ioral disorder. Consequently, I do not believe that it makes conceptual sense for neurology and psychiatry to be separate disciplines. (I confess to be in a small minority in this view.) I strongly believe and advocate that psychiatry and neurology they should be integrated into a single discipline, 'the Clinical Neurosciences.' I see very few patients with psychiatric illnesses without neurological elements. And I see very few patients with neurological illnesses who do not have psychiatric concomitants. Q | You treat people who come from a variety of different backgrounds and income levels. Would you say that mental illness is an equalizer? A | Yes, mental illness is an equal opportunity affliction. Using the most conservative diagnostic criteria and statistics, one in four adults and one in 10 children have a diagnosable men- tal disorder in any given year. Elderly people have a higher prevalence of neuropsychiatric disorders; so, with the aging of our population, mental illnesses will be even more common. When serious mental illness does occur, it has profound implications for the individual and his or her family. People have greater difficulty in school, in carrying out their responsibilities at work, and in caring for their families. The economic effects of psychiatric illness can, therefore, be profound—with lost hours at work and with the high costs of professional care. Thus with severe and persistent mental illnesses, people's incomes and socioeconomic status tend to drift downward. The good news is that effective psychiatric care can be very helpful in mitigating the pain and suffering of our patients, as well as the long-term financial conse- quences of mental illness. Q | What should we be doing to support those facing mental illness? A | The first thing is to listen closely to what our patients and their families are telling us about their conditions. About what and how they are feeling; about what bothers them the most; about what they believe 'caused' their suffering; about what they believe will be helpful in alleviating such. Secondly, as care- givers, we must be available when they are suffering and call on us. Access to care and early intervention is essential to reduce the neurobiolic morbidity and patient suffering associated with all psychiatric disorders. Third, we must allocate sufficient time for our patients to communicate with us and to address their needs. Hospital lengths of stay and outpatient appointments are much too brief to provide optimal care. Much of this is a result of government and insurance reimbursement standards, and we must all work to change this abomination that is a consequence of stigmatization of the mentally ill. Fourth, we must not shame or blame people for their psychiatric disorders— such as by saying to a person with depression: 'Shake it off; pull yourself up by your bootstraps.' When patients tell me that's what a family member or friend has said to them, I reply, 'I know that your brother was well intentioned. But what if you have hypothyroidism? Can you pull your thyroid levels up by its bootstraps? Could you shake off a low thyroid level? There are neuro- biological changes associated with depression that must be addressed in order for you to feel better. You will also have to do everything in your power to help out—such as with diet, exercise, pushing yourself to be with people, etc.' Q | Do you have any upcoming projects or things you are working on that you are excited about? A | Yes, this is such an active and excit- ing time in our field. Everywhere I look there is an opportunity to participate in great breakthroughs in our understand- ing of psychiatric disorders and in the delivery of effective psychiatric care. All of our many outstanding institutions in the Texas Medical Center already work together closely to care for people with mental illnesses, and we will continue to do so. One current project that we are working on as a community is to build a neuropsychiatric research institute on the beautiful new Mental Health Epicenter Campus of the Menninger Clinic. Our plan is to provide ground- breaking research in that facility that will be translated rapidly and directly into respectful, compassionate and effective patient care. In that proposed facility, which is a joint project of Menninger Clinic and Baylor College of Medicine, a new generation of medical students, residents and mental health professionals will be educated in behav- ioral health. The architectural plans for the new institute have been completed, and we have raised from the generous Houston community—and far beyond— over $12 million dollars towards the $25 million goal. For the full interview, visit TMCNews.org Over the past decades we have been working much more effectively as multi-disciplined teams in our care for people with mental illnesses. although we have a very long way to go in this regard, diagno- sis and treatment are far more evidence-based.