Feature Stories

Shedding Light on Mental Illness
by Darla Brown

     As the second leading cause of disability, half of all Americans will experience a mental disorder at some time in their lives. This year alone, more than 3.2 million Texans will suffer from some form of mental illness.

     But despite the growing numbers, mental illness is a problem many are reluctant to address. The stigma of mental illness is a battle that is still being fought by patients, physicians, and other advocates.

      Fortunately for the residents of the greater Houston area, The University of Texas Medical School at Houston is shedding light on mental illness, providing a unique complement of services to a growing patient population.

     Home to a department-run psychiatric inpatient facility, a flourishing outpatient service, and an incredibly productive research component, the Medical School’s Department of Psychiatry and Behavioral Sciences has distinguished itself as a leader.

     “We are unique in the public sector for having part of our mission as education and research,” said Robert Guynn, M.D., chairman of the Department of Psychiatry and Behavioral Sciences.

Addressing the community’s needs
     Members of the Medical School’s Department of Psychiatry and Behavioral Sciences faculty care for patients at the inpatient UT-Harris County Psychiatric Center (UTHCPC) and at the outpatient Mental Sciences Institute.

      “I’m not sure that there is another psychiatric hospital in the country run by a medical school department,” said Dr. Guynn, executive director of UTHCPC. “A department running a hospital has a different feel about it – all of our physicians are faculty members, and they are the only ones who can admit patients there.”

      UTHCPC is a 250-licensed-bed acute care facility that the department has run since its opening in 1986. The public hospital accepts patients of all ages and is the only inpatient facility run by The University of Texas Health Science Center at Houston.

      Since 1990, UTHCPC has consistently increased the number of patient admissions while reducing the average length of stay.

       “Despite adding beds over the years, we have not had an increase in funding from the state or county since 1986,” Dr. Guynn added.

      UTHCPC receives 85 percent of its tax-based funding from the state, 15 percent from the county, and receives its remaining income through third-party payers.

A unique setting for education
     UTHCPC now admits about 6,000 patients a year, who provide a variety of learning opportunities for Medical School students and residents. The teaching hospital offers the stimulus of the student-faculty relationship, offering progressive services to patients.

     “It makes their education better,” Dr. Guynn said, “because teaching goes on across the hospital — not on just one or two teaching units. There is a fully integrated approach with the hospital’s entire staff of nurses, aides, psychologists, counselors, and therapists.”

     Each year, about 300 medical students come through the doors of UTHCPC. Second-year medical students spend five afternoons at UTHCPC, learning how to interview patients; third-year students spend two months in a required psychiatric rotation; and fourth-year students may take electives in psychiatry.

      Eight new residents from the Department of Psychiatry and Behavioral Sciences are accepted into the UT program each year. They spend the first 18 months of their four-year program at UTHCPC and their third year providing one-on-one outpatient psychotherapy at the Mental Sciences Institute.

     “Once a resident has left our training program, he or she can handle anything,” Dr. Guynn said.

      In addition, UTHCPC is a training ground for undergraduate, graduate, and postgraduate students in other health-care fields, such as nursing and pharmacy.

Integrating outpatient care with research
     To supplement the inpatient facility and to provide a continuum of care, members of the Department of Psychiatry and Behavioral Sciences’ faculty treat outpatients at the Mental Sciences Institute (MSI). More than 8,000 patients are seen and treated at MSI each year.

     MSI boasts several clinics aimed as specific patient populations: geriatrics, child and adolescent psychiatry, anxiety disorder research, treatment research center, psychological assessment, developmental neuropsychology, mental retardation and developmental disabilities, and the Center for Human Development Research.

     MSI also serves as the primary research center for the department, which puts a high priority on research as an integral part of patient care and education.

      Many of the outpatients are involved in the patient studies and clinical research headed up by department faculty. More than half of the faculty members at MSI are involved in research, and they have a steady flow of graduate students and postdoctorate students who also participate.

      “We encourage our residents to do research,” said Alan Swann, M.D., the department’s vice chairman for research. “In their third year we focus on clinical research, and they do clinical care of extremely challenging patients and receive research design information so that they can write a research protocol.”

Prolific research
     The department consistently ranks in the top five of all Medical School departments when it comes to research expenditures. In fiscal year 2002, the department received more than $4 million in research funding, which accounted for 4 percent of the Medical School’s total research dollars.

     Researchers in the department are studying the full breadth of mental illness, from developmental disorders – the cognitive aspects of attention hyperactivity disorder and autism – to determining how basic mechanisms of behavior – impulsivity, aggression, and motivation – are related to such psychiatric disorders as substance abuse, depression, and suicide.

     “We run the whole gamut of types of research and disease, which makes this department different,” said Dr. Swann, the Pat R. Rutherford Jr. Chair in Psychiatry. “We are looking at illnesses that are society’s most common problems.”

     The most funded topics of the department’s research are substance abuse treatment, aggression and impulsivity, and human development. “We also have significant interests in bipolar disorder and neuroimaging,” Dr. Guynn said.

     Researchers use humans and animals to understand brain functioning and also study which new treatments work, or how to predict what treatment would work best in a certain patient.

     “In addition to the basic science research, we do a lot of human lab work, and have one of the best facilities in the country studying impulsivity and human aggression,” said Dr. Guynn, director of MSI.

     Historically, the department has always had a strong research program.

     “We were a small department up until the 1980s, when we expanded to include MSI, which was TRIMS,” Dr. Swann said. (See Then and Now, page 36) “That addition was associated with a big expansion of research in the department, including the recruitment of many substance abuse researchers.”

     The addition of UTHCPC also increased the department’s research opportunities, although the majority of the department’s research is carried out at MSI.

     The volume of research has resulted in groundbreaking discoveries. “We had the first placebo-controlled study of large size that showed an anti-convulsant was as valuable as lithium in treating mania,” Dr. Swann said. “We also are looking into new treatments in bipolar disorder and schizophrenia and determining the stability of the two diagnoses.”

Specialty care
     The Houston Recovery Campus, while not run by the Department of Psychiatry, has been operated by UT-Houston since 1995 and provides substance abuse treatment to indigent residents of Harris and surrounding counties.

     The Medical School’s Division of Urban Family Medicine in the Department of Family Practice and Community Medicine staffs the medical clinic there. HRC also offers outreach programs, employment and housing assistance, and health education.

     “Our faculty can refer patients there, but HRC is not officially a part of UTHCPC,” Dr. Guynn said.

     The Department of Psychiatry and Behavioral Sciences is affiliated with the UT-Houston Employee Assistance Program, which provides access to university and medical resources, including treatment specialists.

     While the EAP has its own therapist to assist UT-Houston employees, patients are referred to department faculty if they need more specialized care. EAP serves not only the UT-Houston employee population but has contracts with more than 40 other educational and medical facilities
.
     “It’s just as important for us to care for our own employees as it is for the community,” Dr. Guynn said. “With our range of services and our research to improve treatment and diagnosis, we are well equipped to serve our region’s growing population regarding this pressing need.”

« Back to Top