Prevention Becomes 4th Revolution in Psychiatry

To retired Beverly Hills pediatrician Simon Wile, mental illness in the United States has reached epidemic proportions. “With any other disease, it would be called an epidemic,” Wile said, mentioning the staggering but generally accepted statistics that 19% of American adults have a diagnosable mental illness, and one out of seven U.S. children has a significant mental or emotional disorder.

But until now, the response, he says, has not been to treat it like any other epidemic--which in addition to emphasizing a cure would focus on prevention.

Last month--embodying what its sponsors see as the very future of mental health care--a new UCLA-sponsored Center for Preventive Psychiatry opened its doors on a shoestring budget in cramped, rented offices in Westwood Village.

The brainchild of Dr. Louis Jolyon West, director of UCLA’s Neuropsychiatric Institute and Hospital, the center is the first facility in the nation designed to focus on early detection and prevention of mental and emotional disorders. Its founders are still searching for more financial backing.

Wile, who said the concept of prevention of mental illness and the creation of such a center has been a personal dream of his for more than 20 years, is spearheading the formation of a community support group to assist in the fund-raising effort and is on the center’s community advisory board. He believes the center “will become a replica throughout the world for early recognition and early intervention of mental illness.”

To West’s knowledge, the only other preventive psychiatry center in the world is one at the Karolinska Institute in Stockholm. It is set up primarily, he said, for research.

More Than Research

Center officials at UCLA, however, plan to do much more than research. The center, which has the support of other university schools and departments, including pediatrics, medicine, public health, social welfare, law, nursing, education, psychology and sociology, will develop models for preventive mental health care for children and families in high-risk groups, conduct studies of prevention techniques, train health care professionals in new prevention approaches and formulate educational programs for teachers, parents and other community health-care givers.

Its ultimate goal: the means and resources to identify high-risk groups and individuals, to intervene and prevent mental illness before it arises.

West admitted that it is more difficult to raise funds for mental health disorders than for other kinds of diseases, even though he and other psychiatrists and physicians involved with the project cite a litany of discouraging statistics:

--43 illion American adults have a diagnosable mental illness, according to the National Institutes of Mental Health.

--Of the one in seven children in the U.S. with a significant mental or emotional disorder, fewer than one out of five receive any treatment.

--Suicides among the nation’s teen-agers have tripled since 1950. Nine out of every 100,000 youths--ages 15-19--commit suicide.

More Money

“Heart and cancer societies are able to raise more money than mental health,” West said. “It is easier for people to understand how research for heart disease or cancer can lead to improvement for them. Or they want to give money to strike back at the disease that killed a member of the family. But if a person commits suicide, the family is less likely to say to friends ‘Let’s try to raise money to support research in this field.’ ”

Still, West remains optimistic on the outlook for the Center for Preventive Psychiatry, which will be moved into the new Mental Health Center at UCLA when that facility is completed in about two years. “Times are changing. The public is far more educated and knowledgeable about the many different kinds of mental illness than it used to be,” he said. “It’s not seen as a manifestation of morals or a divine culpability.”

Wile, for one, is particularly concerned about the increasing instance of emotional illness in children.

“Sixty years ago when I started practicing, it was 10%,” Wile said. “Now it’s doubled. It is imperative that we devise some method of reaching these children. The answer is early recognition and following through on it, just what the center is intended for.

“In health and in illness, the mind and body are inseparable. If we start out by training our doctors in medical school of the importance of physical and mental health, the doctors and psychiatrists can work together. I can see the day when the pediatrician and child psychiatrist will be making rounds together.”

The center’s first program will be Oct. 9-11, when it sponsors the first UCLA National Conference on Preventive Psychiatry, entitled “The Prevention of Mental Health Disturbances in Childhood.” The conference is being partially funded by a grant from the U.S. Public Health Service, and another grant for the 1988 conference already has been applied for.

Wile added, “But Drs. Salk and Sabin didn’t walk in the laboratory on a Friday night and walk out on Saturday morning and say ‘We’ve got it.’ This is going to take a lot of time. But what they did for polio, I believe we can do for mental health with this concept.”

West said that two years ago Dr. Stephen Goldston, then director of the Office of Prevention at the National Institutes of Mental Health, contacted him about the possibility of setting up “a multidisciplinary center for preventive psychiatry. Steve was looking for a place where they might be wanting to organize such a center. He could see from the catbird seat where he was sitting in Washington that prevention was the way we were going.

Fight for Funds

“The university doesn’t provide funds for this,” West said. “But I have the freedom to create a new entity if I can find the space and the money for it. Dr. Goldston and I were prepared to gamble on this.”

A year and a half ago, Goldston retired from his government job after 24 years and moved to Los Angeles to be the center’s associate director. He has been in the process of setting up prospective programs for the center, applying for grants, both federal and foundation, formulating proposals for workshops and seminars.

“This is the future of psychiatry, for the mental health field,” said Goldston. “The way is toward prevention, developing models, evaluating research and writing manuals so that mental health people are not just doing treatment, but prevention. We’ll also be doing community service.”

Dr. Milton Greenblatt, a former Harvard professor and professor emeritus of psychiatry at UCLA, is the center’s director. He proclaims the prevention approach to be the fourth revolution in psychiatry.

“There were three revolutions,” said Greenblatt, who describes himself as “a professor emeritus on recall, which means I continue to work, do research and be paid.” He currently is chief of psychiatry at Olive View Medical Center in Sylmar.

“In the first revolution, we took off the physical chains; the second, the Freudian revolution, we took the mental chains off; and the third was the social revolution, taking off restraints society puts on man. Now we come to the fourth, turning of our attention to prevention of mental illness altogether before it arises. A lot of people have been thinking about it (prevention) all these years. Now, we’re doing it.”

Goldston predicted: “We’re doing something against a lot of odds, but it’s going to work. Within a year or so, people will be traipsing out here trying to see what we’re doing.”