Andrew E. Skodol, M.D.

Keynote Address

The Business Journal

Arizona Biltmore Resort & Spa

Phoenix, AZ

August 23, 2007

Thank you, Don and Ilana, for the opportunity to speak at this year's Health Care Heroes Breakfast.  It is a privilege to be with all of you today.  I am excited and looking forward to being a part of Arizona's healthcare and scientific communities, particularly at this time of major growth and focus on positioning Arizona as a leader in scientific research.

I congratulate all of you, the often unsung heroes of health care.  I am in awe of your passion, commitment, and talent.  I chose to relocate to Arizona in part because of how impressed I am with the work that is being done in the community.  With people like Dr. Beyda, Ms. DeJaeger, Ms. Frisby, Ms. Vanca, Ms. Lehker, Mr. Montgomery, and all of the nominees serving our community, our health is in good hands.  

Like all of you, I have a passion and a vision for a healthy community.  My passion for mental health began in medical school, where I realized that to help sick people often required attending to issues and concerns beyond treating their physical signs and symptoms: issues and concerns involving their families, their jobs, their hopes, and their fears.  In psychiatry, I was lucky enough to find a discipline that embraced these concerns and did not regard them as interferences.  My interest in research was stimulated and has been sustained by the challenge of how much we did not, and do not know yet, about the workings of the human brain and mind.

 As Health Care Heroes, I know you understand that a healthy community is one that is focused on both the mental and the physical well-being of its residents. Our new organization, the Institute for Mental Health Research, was founded by a handful of wise Arizonans who appreciate the crucial role of mental health in maintaining the vitality of this beautiful state.

A prominent politician once said, "My job today is to talk; your job is to listen.  I sure hope you do not finish before I do."  I'll try to cover key points of what I see as the current state of mental health in our country and, more specifically, in Arizona.  I will also try to share a vision of where I think we can go.  And, I'll try to do this all before your attention wanders.

I want to leave you today with 5 "truths" about mental illness and mental health in Arizona:

First, Mental illnesses are common.

Second, Mental illnesses are costly.

Third, Although effective treatments exist, mental illnesses often go untreated.

Fourth, Research holds the key to better diagnosis, treatment, and prevention of mental illness and to the promotion of better mental health.

And finally, With your help, the Institute for Mental Health Research can play a significant role in advancing the understanding, treatment, and prevention of mental illness and enhancing the quality of life for the citizens of Arizona and the nation.

FIRST, HOW MANY PEOPLE SUFFER?

Mental illness is pervasive in our society.  More people suffer from depression than heart disease, cancer and AIDS combined.  According to the United Nations, by the year 2020, depression will be the second leading cause of disability in the world. It affects all of us in some way.  According to the Surgeon General, each year in the United States, 1 in 5 adults has a diagnosable mental illness.  That means that, on average, at each table in this room there are two people who are dealing with some form of mental health problem.   It could be depression or anxiety, it could be relationship issues -- mental health is not just a concern for those with graver problems such as schizophrenia.

Additionally, according to the American Psychological Association, one in four -- or 15 million -- children and adolescents in the United States have a mental or behavioral health problem that is interfering with how they function at home and at school.  That means, at your table, the lives of at least two of you are also impacted by the mental health of your child.  Few of us, if any, are untouched.

WHAT ABOUT THE COSTS?

Since this is a healthcare-oriented audience, I know you will understand when I say that people with untreated mental illness cost everyone.

•·         Obviously, there are huge COSTS TO INDIVIDUALS.  It is estimated that 90 percent of suicides are associated with mental illness.  Did you know that more than 800 people commit suicide in Arizona every year?  That's more than two people per day who kill themselves.  The number of suicides in Arizona is double the number of homicides each year.  We have the sixth highest suicide rate in the nation, and we consistently rank in the top ten states.

•·         The COSTS TO OUR FAMILIES are also potentially devastating. Maternal substance abuse and depression in the perinatal period are associated with child and adolescent emotional and behavioral problems that may have life-long consequences.  Adolescents with mental disorders are more likely to become involved in abusive adult relationships, which in turn also increase risk of childhood behavioral problems, creating a so-called "cycle of violence."  

•·         The COSTS TO SOCIETY are striking and also sad.  Homelessness, crime, and violent behavior have all been associated with mental illness.  In Maricopa County, criminal justice spending has more than doubled over the past decade.  Part of this cost is for psychiatric treatment for mentally-ill inmates, who are now institutionalized in prisons, rather than in mental hospitals. 

•·         And all of you will be able to appreciate in particular the COSTS TO THE MEDICAL COMMUNITY.  Four out of five people in the United States with often debilitating mental illness are not receiving effective treatment.  Yet, on average, when given treatment, 80% can improve.  Those with untreated mental illness consume two to four times the health care resources, and are using non-psychiatric inpatient and outpatient services three times more than those who are treated.  50% of visits to primary care practitioners result from patient symptoms unexplained by a physical illness but often associated with depression or anxiety disorder -- symptoms such as chest pain, fatigue, sleep disorders, chronic back or joint pain, or abdominal discomfort.  These symptoms can lead to the overcrowding of emergency and other healthcare facilities, as well as unnecessary and expensive testing.  Also, depression makes the work of health care professionals more difficult.  Depression considerably worsens the prognosis of many physical illnesses because it hinders adherence to treatment regimens, impairs physical and cognitive function, diminishes quality of life, and decreases the rate of survival.

•·         Finally, the COSTS TO BUSINESS are staggering.  Mental illness has more effect on lost productivity, increased absenteeism, and other indirect costs to business than any other health problem, according to a national survey by the American Psychiatric Foundation.  More workers are absent from work because of stress and anxiety than because of physical illness or injury.  Employees with depression alone cost employers $44 billion per year in lost productive time.  Overall, untreated mental illness is estimated to cost businesses and society $204 billion a year.

But this is not solely about dollars, it's about people.  As the Global Medical Director of Dow Chemical said, "Now, the true competitive advantage for businesses and corporations is tied to their people; the added value of healthy employees should show up as an asset on the balance sheet, much like the value of new capital." 

WHY DON'T PEOPLE WITH MENTAL HEALTH ISSUES GET TREATMENT?

Let's talk for a minute about STIGMA.  Mental illness is a topic that is sometimes embarrassing to talk about and is often avoided in conversations, even among family members or close friends.  I want to address that for a minute, because mental illnesses are equal opportunity conditions that do not discriminate. Many talented, brilliant, and powerful people suffer from different forms of mental illness.

Too often mental illness goes untreated because of stigma.  Fortunately, many notable people have come out to speak about their mental illness and the effective treatment they received in recent years.

•·         Mike Wallace would not get help for his depression because he was ashamed.  He has said that everyone on 60 Minutes breathed a sigh of relief when he finally got treatment.

•·         Actress Brooke Shields suffered from severe postpartum depression after the birth of her baby in 2003. She has been very outspoken about her struggle and her treatment.  She said that she "could deal with the medical part of the illness and its treatment, but the label was very uncomfortable and shameful."

•·         Tom Johnson, who ran CNN for 11 years, did not seek treatment for his depression for many years because a CEO is -- in his words -- "supposed to be strong, stable and dynamic."

•·         Jane Pauley finally received treatment after she was hospitalized for her bipolar disorder.

Did you know that it is estimated that half of U.S. Presidents serving between 1776 and 1974 had some form of mental illness?  Researchers at Duke University reviewed presidential biographies, histories, medical studies, and journals and then asked independent reviewers to make psychiatric assessments.  Their assessment found that 24% of presidents suffered from depression, 8% from anxiety, 8% from bipolar disorder, and 8% from alcohol abuse or dependence.

The Duke researchers hope that their findings lessen the long-standing stigma of mental illness.  In addition, the researchers note that the illnesses of these presidents are readily treatable today. Mental illness is like other illness.  It can be treated successfully and treatment should be encouraged.

Science has advanced the precision of diagnosis and the effectiveness of treatment. Metal health professionals can now diagnose mental disorders with the same or better accuracy than radiologists read chest x-rays or cardiologists interpret EKGs.  Extreme forms of disorder can now be treated with medications with relatively mild side-effects instead of with wet sheets or insulin-induced comas.  Many types of psychotherapy have been tested and found to be effective for a wide range of conditions.  In the future, we may be treating depression with magnetic fields instead of electric shocks and schizophrenia with gene therapies instead of tranquilizers.

But, then there is the problem of ACCESS.  Despite scientific advances, mental illness will not be treated if treatment is not available or cannot be afforded.  A striking impression that I have had since coming to Arizona is that while pockets of clinical excellence in certain areas exist (Alzheimer's Disease being a good example), there are also many holes to fill.  Many Arizonans who I have met continue to take their loved ones out of the state to seek mental health care, if they can afford to do so.  Others, however, undoubtedly cannot afford treatment even if it is available locally.

WHAT IS THE ROLE OF RESEARCH? 

Although we have made huge strides in being able to diagnose and treat mental illnesses, we do not yet really know why some people develop devastating mental illnesses and others do not.  Nor do we know nearly enough about the factors that promote mental health and the ability to deal in healthy ways with life's adversities.  We can contain, but we cannot yet cure diseases of the human mind, let alone prevent them, but we are working towards those goals. And, scientific research holds the key.

WHY WAS THE INSTITUTE FOR MENTAL HEALTH RESEARCH CREATED?

The mission of the Institute for Mental Health Research is to discover the causes of mental illness and to identify the factors that promote mental health and well-being.  Our approach is to fund and promote scientific research across the lifespan from childhood to late life.  Research shows that most mental illnesses begin in childhood and, if untreated, may persist through much of adult life.  Factors associated with good mental health are also often evident or develop at an early age. 

Let me give you some examples of cutting-edge mental health research happening across Arizona.  The Institute for Mental Health Research has funded 22 different scientists working at 8 different academic and healthcare institutions in the state over the past 3 years.  Since the inception of its small grants program, the number of researchers identified as doing mental health research in Arizona has increased by 70%.  There are many great examples of IMHR-funded research, but in the interest of time, I will only mention a few:

•·         Dr. Dietrich Stephan is studying autism at the Translational Genomics Research Institute (TGen).  His research focuses on identifying the genes that predispose children to autism and could lead to tests to detect autism before it appears clinically and provide an opportunity for early intervention.

•·         Dr. Felipe Castro at Arizona State University in Tempe is studying resilience (which is the ability to deal in healthy ways with life's adversities) among Hispanic adults.  His research focuses on whether or not leadership qualities reflect social, cultural, and personality sources of resilience in the hopes of developing programs to build greater resilience among Hispanics and their families, as well as in other special populations.

•·         At the University of Arizona and the Arizona Cancer Center in Tucson, Dr. Karen Weihs is studying how to treat cancer patients for depression.  Since 25%-50% of cancer patients suffer from major depression, the goal is to enhance and prolong patient lives.

•·         Dr. Martha Kent is exploring the loss of resilience among veterans experiencing posttraumatic stress disorder. The goal of her study is to reestablish resilient responses to stress and trauma in the lives of individuals with PTSD. Dr. Kent's work is being done at the Carl T. Hayden VA Medical Center in Phoenix, in collaboration with the Department of Psychology at Arizona State University.

•·         Dr. Cynthia Stonnington is studying the early detection of Alzheimer's Disease at the Mayo Clinic Arizona in Scottsdale.  Her long-term goal is to develop a cognitive stress test that will predict who is at risk for developing Alzheimer's Disease prior to the onset of any cognitive decline.

WHAT EFFECT HAS IMHR SUPPORT HAD ON RESEARCH FUNDING? 

Institute for Mental Health Research grants are designed as seed money and are intended to fuel new scientific research by attracting outside grant and commercial funding to Arizona.  Over the past 3 years, IMHR has invested about $3/4 million in its small grant program.  So far, our seed grants have enabled recipients to obtain almost $4 million in grants from other funding agencies.  This is a very good return on the investment dollar.  The model works.  Two very exciting recent awards speak to the future of Arizona, mental health, and our state as a major research hub. Two Valley scientists who were awarded Institute for Mental Health Research seed grant money and have recently received large grants from outside of Arizona are here with us today.

•·         We are excited to announce that Dr. Heather Allyson Bimonte-Nelson, who received a $50,000 IMHR grant, received $1.6 million from the National Institutes of Health to continue her study of the effects of ovarian hormone loss on memory decline and the development of Alzheimer's Disease at Arizona State University.

And,

•·         Dr. Jie Wu, who is studying whether nicotine may be an effective treatment for some symptoms of schizophrenia at the Barrow Neurological Institute of St. Joseph's Hospital and Medical Center, was recently awarded $700,000 by the Philip Morris Foundation after beginning his research with a $25,000 seed grant.

WHERE CAN WE GO WITH MENTAL HEALTH RESEARCH IN ARIZONA?

Arizona is the fastest growing state in the United States.  The Phoenix metropolitan area tops the nation in projected increase in the number of births from 2005-2010.  Such rapid growth presents considerable challenge, but also opportunity.  Just as hospitals and schools are gearing up for this "kiddie boom," which will change the demographics of Arizona forever, so too must the challenge be met to develop centers of clinical and research excellence in mental illness and mental health across the lifespan.  A recent study in 14 states, including Arizona, revealed that 1 of every 150 children has some form of autism.  Prevalence rates of Alzheimer's Disease have increased 10% in the past 5 years and, absent a cure, are expected to triple by 2050, as the 85 and older population soars and baby boomers move into their late 60s and 70s.  The list of increasing mental health needs goes on.

I came to Arizona from New York and the world-renowned New York State Psychiatric Institute.  One hundred and eleven years ago, PI as it is called, began as a small pathology laboratory in rented space in the Metropolitan Life Insurance Building in New York City. It was the brainchild (no pun intended) of one Carlos F. McDonald, the then newly appointed President of the New York State Commission in Lunacy.  One hundred and eleven years later, PI has an annual budget of $125 million, occupies 500,000 square feet of research and clinical space on the campus of the Columbia Presbyterian Medical Center, employs 1600 people, and can claim research and clinical programs in virtually all aspects of mental illness and mental health.  This success has been predicated on the collaboration of state government, business, academia, and a concerned community, in others words, people just like you.

In Arizona, we have only just begun.  I am thrilled to be leading the Institute for Mental Health Research at such an important time. I am anxious to get to work with all of you.  We are teaming up with many of the institutions and research centers represented in this room to work towards cures for mental illness, to promote better mental health, and to further build Arizona's healthcare and scientific future. 

Together we can reduce the emotional, social, and economic devastations of mental illness;

Together we can make Arizona a state that is recognized for significant mental health research;

Together we can find cures; and

Together we can help the world understand mental illness and what is truly the final frontier -- the human mind.

I look forward to working with you in the years to come.  Thank you so much for your time and attention.