Department of Psychiatry Will Play Major Role in Veterans Center

August 16, 2007

More than a dozen faculty members from the Department of Psychiatry at the University of Rochester School of Medicine and Dentistry will direct programs, conduct research and provide treatment at the new Veterans Administration Center of Excellence in Canandaigua.

Kerry L. Knox, Ph.D., an associate professor of psychiatry and of community and preventive medicine at the School of Medicine, is the director of the Center of Excellence.

The relationship between the Department of Psychiatry and the Center of Excellence will have a tremendous impact on the department, said Eric Caine, M.D., the John Romano Professor and chair of the department who called the Veterans Administration a "natural ally."

According to Caine, there is a clear commitment of the Veterans Administration through the new center and the Department of Psychiatry "to rigorously evaluate the best available approaches to suicide prevention and mental health promotion, which are specifically intended to have a direct benefit for veterans, their families, and their communities now. As well, researchers will be systematically developing new interventions to better the lives of veterans during the years ahead."

Through the new center, the Department of Psychiatry will be working with "the most broadly organized and well developed health system in the United States ," Caine said.

"It will be a real amplifier of our ideas and research and presents us with challenges we’ve never faced before. This is a community challenge and it is important the department addresses it," he said. "We are always building partnerships. This collaboration will reach far beyond Rochester. It opens many doors to improve care and treatment."

Commitment to the Community

The relationship between the department and the Center of Excellence also could lead to the hiring of additional faculty at the University and at the Canandaigua Veterans Administration Medical Center.

"The collaboration between the Veterans Administration and the Department of Psychiatry is an important example of our commitment to community health. We will work together to improve the lives of veterans and their families far from Rochester and our medical center. And what we learn also will help our own community," said Bradford C. Berk, M.D., Ph.D., chief executive officer of the University of Rochester Medical Center and the University’s senior vice president of health sciences.

The Center of Excellence will be a one-of-a-kind prevention center in the Veterans Administration. The center will utilize public health approaches to reduce premature death and treatable illnesses in veterans, with special attention to suicide and attempted suicide, post-traumatic stress and related stress disorders, depression, substance abuse, serious mental illness, and the family and social problems that can arise from these difficulties. As part of its mission, the center will have national responsibilities, as well as local and regional.

The center now is developing the Veterans Administration Suicide Prevention Program, an effort that soon will unfold across the country. The center also will conduct clinical demonstration projects of novel treatments, and establish a national data analytic center for better monitoring of the effectiveness of care.

David S. Guzick, M.D., Ph.D., dean of the School of Medicine and Dentistry, said the Department of Psychiatry’s formative role in creating the Center of Excellence in partnership with the Veterans Administration fits well with the overall mission of the Medical Center.

"An important part of what our faculty do at the medical school is to draw on effective therapeutic methods in individual settings and translate them, with modifications as needed, to specific populations," Guzick said. "The preventive and clinical interventions developed by the Center of Excellence will help the population of veterans in this region and throughout the country."

Need for More Research

The Veterans Administration is setting new standards in terms of addressing the mental health needs for people who have a higher risk of experiencing negative mental health related outcomes due to serving in the military, Knox said.

"The implications are huge for improving the mental health of veterans, but also may be significantly important for the country in general in terms of overcoming the stigma associated with mental disorders and psychosocial problems," she said. "The Center of Excellence at Canandaigua will be at the forefront of the V.A.’s efforts, particularly in reducing the morbidity and mortality associated with suicide and suicidal behaviors."

The personal, family and social costs of disability and death due to mental health disorders are great, Caine said.

"Historically, the country has set a lower priority on dealing with psychological disabilities than physical disabilities despite the cost in lives and the huge burdens they put on families and society," he said. "We are much better in dealing with prosthetics for legs and arms than we are with mental prosthetics. That’s why we have so much research to do."

According to Knox, the Center of Excellence will bring together two approaches to prevention. The first uses "universal" prevention methods across broad populations to enhance the early recognition of needs among veterans. In addition, it aims to promote a willingness to seek care or assistance. Universal approaches deal with social attitudes as well as educating people about specific risks to look for.

The second area of emphasis relates explicitly to "high-risk" groups or high-risk individuals. "Selective" programs aim to engage groups of people -- veterans who repeatedly participated in intense, lethal combat, for example -- where there is a known risk for longer-term personal problems. Not everyone exposed to such risks will develop lasting distress, but it often is very difficult to distinguish those who develop future difficulties from those who won’t. Selective prevention strives to include all potentially in need. In contrast, "indicated" prevention is for those individuals having clearly emerging difficulties.

The difference between the "public health" approach of the new Center of Excellence and current "clinical" services is that the center will aim to reach into communities to find vulnerable individuals while most care providers wait for them to seek services in offices, clinics, or emergency rooms.

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