Thirteenth Annual Research Conference

New York State Office of Mental Health Thirteenth Annual Research Conference

Thirteen years hadn't dulled the excitement surrounding the annual research conference held in Albany each December. With an impressive lineup of speakers scheduled during the three-day seminar and an equally impressive roster of workshops to attend, this latest gathering of mental health professionals and consumers was a triumph for OMH and the entire mental health community.

Setting the tone for the entire proceedings, Dr. Steven Hyman of the NIMH and recipient of the Heinz E. Lehmann Research Award, posed this question: How do researchers make research relevant to the public? The point of research, he noted, is not to claim possession of a grant, but to use that grant to find the best possible treatment for the patient. One way in which to do that is to engage public policy makers, clinicians, and consumers. Hyman found that reaching out to these individuals was most effective in determining how to get relevant treatment to the public and effectively recruit people for clinical trials.

He added that research practices need to be updated, namely: in epidemiology, which neglects certain aspects of the progress of disease; in intervention, so that more stress is placed on effectiveness research rather than on efficacy research; and, in translation of basic behavioral sciences to make it relevant to public health issues.

In wrapping up, Hyman noted that there are enormous challenges to applying the fruits of basic sciences research to all patients. Daunting though these challenges are, researchers need to push forward in understanding and diminishing stigma, eliminating healthcare disparities, improving recognition and intervention in primary care settings, and identifying fiscal and non-fiscal barriers to access. An inspiring end to the first plenary discussion and a great call to action.

During a later evening presentation, Dr. Herbert Pardes of the New York Presbyterian Hospital and former director of PI echoed Dr. Hyman's call to make research applicable and beneficial to the very people it is designed to help. Placing mental health research in a historical context, Dr. Pardes related the progress in mental health awareness among the lay public and the medical community, noting that stigma is still very much in evidence, and stressing the need to integrate mental health with discussion of physical health.

The paper sessions and workshops throughout the three days provided ample opportunity to further explore and illuminate the sometimes provocative and always relevant aspects of the practice of psychiatry and the delivery of mental health services. In her presentation on the co-occurrence of domestic violence and child maltreatment with mental disorders, Dr. Sandra Kaplan of North Shore University Hospital related that in the last decade it has come to light that child and adult mental illness play a significant role in the manifestation of these violent behaviors. The majority of abused children exhibited more risk factors for suicide compared to children who were not abused. Additionally, children exposed to domestic violence were more likely to suffer post-traumatic stress disorder. The perpetrators of the abuse were more than likely to have suffered abuse themselves and to have battled depression and alcohol abuse. Yet, given this, there is a dearth of funding, research, and training in the area of domestic violence and mental illness. Intervention by mental health providers is still met with great resistance, said Dr. Kaplan, and this bias occurs on the federal level.

Dr. Pamela Collins of PI and colleagues from Columbia and the School of Mental Health presented their findings of a study exploring sexuality and HIV risk among women with severe mental illness. The study established the importance of paying special attention to contextual issues unique to this population, such as the impact of stigma of mental illness as well as gender-specific concerns. This knowledge, the researchers believe, will lead to development of preventive intervention that more fully meets the needs of women with severe mental illness.

On the legal front, the New York State Office of Mental Health, in conjunction with local government, has been evaluating the impact of Kendra's Law and Assisted Outpatient Treatment (AOT). The AOT is a court-ordered treatment for people with certain mental illness and who are unlikely to function in their community. Since Kendra's Law was enacted in New York State in 1999, few studies have looked at the impact it has had, even though most states have some sort of assisted outpatient treatment. After a year, the OMH has found that the program has engaged more hard-to-serve individuals in the mental health system because of service enhancements and has increased discussion in counties of high-risk individuals. However, concerns about priority given to AOT individuals over other consumers, general lack of knowledge about AOT, and keeping track of individuals who travel from one county to the next are ongoing issues.

A wealth of information was conveyed and exchanged during the live plenary panel on Risk Factors for Violence in Patients with Mental Illness. The panelists were Dr. Paul S. Appelbaum, Vice President of the American Psychiatric Association, and John Monahan, one of the authors of the recent MacArthur Study of the Relationship of Mental Illness to Violence. Dr. Biman Roy of the Nathan Kline Institute presented a case study. Questions from the audience generated lively discussion on issues such as balancing individual patient rights with the need to protect all patients and the increasing burden placed on the mental health profession to incorporate violence under the mental health umbrella.

Probably the most interesting panel to date, the closing plenary discussion on Mental Illness and the Court System, included Judge Ginger Lerner-Wren of Florida, Catherine M. Abate, J.D., and Former Chief Judge Sol Wachtler. Speaking from a unique vantage point, having witnessed the workings of the criminal justice system from both sides of the bench, and having been diagnosed with bipolar disorder, Judge Wachtler presented an insider's view of the life in prison for the mentally ill. Numbed by drugs, mentally ill prisoners are shuffled from facility to facility. Today, he said, prisons are the largest public institutions proving "treatment" for the mentally ill. Catherine Abate, J.D. said that in a 1998 survey, the Federal Bureau of Justice Statistics found that 239,800 mentally ill people were incarcerated in U.S. jails and prisons. In response to this dismaying practice in her own state, Judge Lerner-Wren of Florida established a Mental Health Court designed to find and provide treatment for the mentally ill entering the jail system. In operation for three and a half years, the court takes a non-punitive approach and is therapeutically based. Perhaps one enlightened approach, suggested Abate, would be to train officers to intervene with a mental health provider prior to arresting an individual who is mentally ill.