April 6, 2001
Volume XXXIV, No. 14


Making the Rounds

Of Note

Retirement Roundup


World to focus on mental health in April


The World Health Organization (WHO) has selected Saturday, April 7, to focus worldwide attention on the importance of mental health.

Each year, WHO experts select an area of health that needs global attention. This year's theme is "Mental Health: Stop Exclusion - Dare to Care."

The two universal messages that WHO is hoping to convey this year are:

  • All societies need to focus on a reduction in the gap between persons with mental health disorders and available treatment.

  • The pervasive effects of social exclusion, resulting from stigma and discrimination, and the outdated nature of many mental illness services, prevent people in need from seeking treatment.

According to psychiatry chairman Dr. Charles Bowden, the Health Science Center has four major projects addressing these global issues. "We serve as sites for two unique studies with public health implications for persons with bipolar disorder and schizophrenia," he said. "These are the largest studies ever conducted focusing on the long-term course of these two most serious chronic psychiatric disorders. Each study is conducted at more than 15 major centers in the country with aims to enroll several thousand patients, follow them over five or more years, and learn about details of the effectiveness of different treatment strategies in ways simply not possible by smaller studies conducted at one center."

Dr. Bowden is the principal investigator for the bipolar study. Dr. Alexander Miller is the principal investigator for the schizophrenia program.

"Also, we have two programs designed to address inadequate treatment for two groups of the mentally ill," he said. "One is 'Demand Treatment,' which is aimed at improving public awareness of the need for, and securing more funding for, treatment of alcoholism and other addictions. The other is a jail diversion program, designed to provide a therapeutic-based alternative to the tragic incarceration of teenagers and adults with serious mental illnesses, in the absence of treatment programs for their illnesses."

On another front, the Health Science Center is involved in the WHO Collaborating Center for Cross-Cultural Research and Training in Mental Health and Psychosocial Factors in Health, which has been working to address issues of treatment gaps and exclusion since its creation in 1993. At that time, WHO members determined that the San Antonio Health Science Center was in a unique position and had the expertise needed to address cultural issues as they relate to mental health and health in general.

The WHO center is dedicated to overcoming communication barriers and equalizing diagnosis across cultural and language lines, as Dr. Sue Hoppe, psychiatry, and Wayne Holtzman of the Hogg Foundation for Mental Health called for in their monograph in 1993, "Search for a Common Language in Psychiatric Assessment."

"The WHO center is pursuing several projects (with additional funding from the Hogg Foundation and the National Institute of Mental Health) that cross cultural and international boundaries," reported Dr. Hoppe, a scientific associate and a member of the executive committee of the WHO center. "Some of our activities are aimed at developing an infrastructure for research, such as tests that can accurately measure certain psychological symptoms no matter what the language, culture or ethnic background of the person being tested."

Other projects of the WHO Collaborating Center include work funded by the Hogg Foundation to develop common terms used to express the experiences of caregivers of persons with mental illness worldwide, and an initiative to study the incidence and prevalence of mental illness in Texas compared to the rest of the nation using a tool called the composite international diagnostic interview (CIDI). Efforts are targeted at South Texas and Mexico, building on strong ties that have developed between the Health Science Center and universities in Mexico City, Guadalajara, Ciudad Victoria, Monterrey and other Mexican cities.

Another example of cross-cultural psychiatric research on campus is the project led by Dr. Michael Escamilla, psychiatry, studying the genetics of schizophrenia and bipolar disorder in families from several countries including Costa Rica, El Salvador, Mexico and the United States.

Non-psychiatric Health Science Center researchers also are shedding light on the long-neglected area of ethnic considerations in mental health care. "A lot of people with mental health needs never visit a psychiatrist or psychologist," Dr. Hoppe noted. "If they have any contact with a health professional, it may be with a primary care physician, who is increasingly able to assess and treat or refer the person for help. The WHO center and other projects on campus are helping to create the infrastructure needed to raise knowledge and skills among caregivers not only in San Antonio and Texas, but in other countries as well."