Psychiatric care is an expensive endeavor for hospitals because public and private reimbursements don’t nearly cover the costs of doing business. But while most hospitals in the U.S. have kept mental health services to a minimum as a result, Massachusetts General Hospital has continued to make psychiatry a top priority. In fact, MGH continues to invest in what has become — 75 years after the opening of its Department of Psychiatry — a broad and deep enterprise in clinical care, research and teaching.
Why? MGH leadership understands and cares about addressing the suffering of patients with psychiatric disorders, and as a major academic medical center, it has a commitment to advance knowledge, improve treatment and prevent all human disease. The commitment to a department of psychiatry in the general hospital originated in 1934. In that year, the Rockefeller Foundation gave a $50,000 grant to the hospital to establish the department. MGH was one of only three general hospitals in the country to receive such a grant, the purpose of which was to integrate psychiatric treatments into the care of medical and surgical patients.
The move enabled a leap forward in medicine, which had previously made a distinction between physical and psychological diseases. Shortly after receiving the grant, MGH appointed a neuropathologist, Stanley Cobb, MD, as the first chief of Psychiatry, and there followed over the course of several decades the building of an illustrious department that has emerged as a major force in advancing knowledge of the brain and treatment of psychiatric illness. By 1994, the MGH Department of Psychiatry had validated the revolutionary thinking of the Rockefeller Foundation by earning the top ranking among Psychiatry departments in the country in the annual “Best Hospitals” survey of U.S. News and World Report. It has kept this ranking every year since.
Over the years, our researchers have also validated the commitments of the Rockefeller Foundation and MGH leadership via cutting-edge research on the treatment and the biological basis of mental illness. They have made groundbreaking discoveries linking genetic abnormalities with specific psychiatric illnesses and have employed powerful new imaging techniques to enable us to identify parts of the brain that dysfunction in mental illness.
As well, the theoretical orientation that defined the department in its earliest days, that mind and brain are one, persists today. Dr. Cobb and his colleagues focused on integrating the psychological theories and therapies of the time with how the brain created mind and mind altered body. Psychosomatic illnesses and the psychiatric care of the medically ill was the department’s central role, and remains to this day a focus of our clinical care — which underpins the esteem and collegiality that MGH psychiatrists enjoy from their medical and surgical colleagues. Indeed, more than 12 percent of MGH inpatients receive psychiatric consultation or care, compared to one percent nationally. Psychiatrists serve on clinical teams across the institution and liaison with many medical and surgical specialty services.
More than 600 psychiatrists and psychologists are affiliated with the department. More than half of its funding supports its research efforts, and our direct clinical services are substantial and comprehensive, vast and specialized, with programs providing clinical care and clinical research across all the major psychiatric disorders, including programs in depression, bipolar disorder, schizophrenia, anxiety and traumatic stress, eating disorders, obsessive compulsive and related disorders, childhood disorders, women’s mental health, addiction medicine, cognitive and learning disorders and more. Many of these individual programs are the size and scope of entire departments at comparable general hospitals.
One of the things we’ve learned over the years in epidemiological studies is how common mental illness is. Depression alone afflicts one in five people. Many suffer privately because of the so-called stigma. These diseases must continue to be studied and better understood so we can move towards improved treatments and early interventions that will prevent onset of the disorders. As with cancer, diabetes and heart disease, we can understand the interplay of innate and environmental risk factors, and work to eliminate these conditions from ever occurring. There is every reason for us to talk in these hopeful terms about psychiatric illness. The new tools available for psychiatric neuroscience, and especially genetics and neuroimaging, make this a time of accelerated discovery.
Indeed, the brain is a terrifically complex organ that happens to give rise to the mind; among its products are cognition, emotions and behavior. So when brain function is impaired, that dysfunction strikes at who and what we are and how we feel, think and behave, which also profoundly affects those close to us.
Through our research, we now know that the causes of these ills are not so different from other medical conditions. Advances that have emerged from our labs in genetics, molecular psychiatry, neuroimaging, and social and behavioral neuroscience mean the future will be very different for those with psychiatric disorders.
And that leads me back to where I started — at the bottom line, in dollar terms. It is increasingly evident that national leaders and the public understand the urgency and opportunity facing us in this field. In fact, one of the hospital’s biggest gifts in history was from an anonymous donor for the support of psychiatric research and care. While neuroimaging is so critical to the understanding of mental illness, the technology that allows us to examine our organs in real time is costly. So too are studies that require gathering vast amounts of clinical and genetic data from large populations, as are many of our clinical research endeavors to improve the therapeutic armamentarium. We view our clinical duty as requiring the expertise to treat successfully where others have tried and failed.
To be sure, these most promising avenues for exploration in the field of psychiatry will require continued investment if our next 75 years are to be as fruitful as our first.