Carl C. Bell, MD

As a prevention-focused, public health psychiatrist, I am committed to proactively addressing the needs of patients with mental health problems. In light of this commitment, I want to bring to your attention several recent advances in prevention in psychiatry.

When Dr. David Satcher served as the 16th surgeon general, during his 2000 Conference on Children’s Mental Health, he suggested three areas of focus for mental health professionals that would lead to improving the public’s health: protective services, special education, and juvenile justice. Taking his advice, many of us have been working in these areas and gaining some ground.

Child Protective Services

More than a decade ago, some disturbing trends became apparent in downstate Illinois in McLean County. Although the statewide average of removing children from their families was 4/1,000, child protective services in that county were removing 40/1,000 children from their families.

The director of the Department of Children and Family Services (DCFS) learned about this problem and sent Community Mental Health Council (CMHC), and Urban Services, downstate to fix this problem. CMHC is a mental health center that uses evidence-based practices to serve its community in Chicago, and Urban Services is a social service agency that seeks to support communities by improving their social cohesion and control. By using a seven-field principle model that strengthened families, we were able to reduce the number of children being removed dropped from 24.1/1,000 down to 11.1/1,000.

Furthermore, follow-up studies indicated children and families in the intervention were far less likely to have subsequent hotline calls, compared with those not in the intervention. Thanks to the leadership of several subsequent DCFS directors, slowly but surely, Illinois began to infuse intact family services into their agency.

The result was Illinois was able to reduce the number of children being removed from their homes from 4/1,000 down to 1.8/1,000. Fortunately, for the nation, President Barack Obama appointed Bryan Samuels, a former DCFS directors who infused a prevention into Illinois DCFS, as the commissioner of the Administration of Children, Youth, and Families, and he is on a mission to spread what he started in Illinois to the entire nation.

Youth in Special Education

Earlier this year, I realized that fetal alcohol syndrome (FAS) was a serious contributor to the four major and common problems children have (speech and language disorders, attention-deficit/hyperactivity disorder, specific learning disorders, and mild mental retardation).

It is interesting to me how focused psychiatry is on neuropsychiatry and brain imaging, but as far as I know, there is no objective test available to diagnose FAS other than the characteristic facies with which a child with serious FAS is born but gradually outgrows, making it difficult to diagnose an adolescent or adult.

Someone once suggested that if I suspected any of the four major and common problems of children, I ask to see a baby picture to see whether I can recognize the characteristic facies of FAS. While I am more a fan of clinical medicine/psychiatry than I am of laboratory medicine/psychiatry, I wonder why our neuropsychiatric researchers have not tackled this common problem.

Regardless, the problem of FAS does seem to be on federal radar as a potentially major prevention initiative, and the Substance Abuse and Mental Health Administration is certainly aware of the problem as the agency cites fetal alcohol spectrum disorders as more common than autism. Fortunately, some states are ahead of the curve (for example, Alaska and Washington states), and there is a National Organization on Fetal Alcohol Syndrome (NOFAS). Hopefully, the observations about the huge impact that FAS makes on special education will pan out, and we will see some prevention traction in the area of special education – as we did with cretinism and phenylketonuria.

Youth in Juvenile Justice

For me, providing treatment to young people who have wound up in the juvenile justice system has been the toughest challenge, because the psychiatrist’s ability to influence such systems is minimal. However, a recent National Academy of Sciences (NAS) report – "Reforming Juvenile Justice: A Developmental Approach" – has just been released, and, if this report gains footing in the United States, we will all be much better off.

As director of the Institute for Juvenile Research (IJR) – where child psychiatry started – I am familiar with the development of the first juvenile court in the United States. It was shortly thereafter that the same group of women (led by Nobel Prize–winning social workers Jane Addams and Julia Lathrop) who developed that special court began IJR to study delinquency. It turns out more than 100 years later, we are rediscovering their wisdom as the new NAS report illustrates.

So, prevention is alive and well in psychiatry. The construct of prevention in psychiatry has even made its way beyond the specialty. Take, for example, the Wikipedia entry on mental disorders – which has a subsection on prevention.

Dr. Bell is president and chief executive officer of Community Mental Health Council Inc. in Chicago. In addition to serving as director of the Institute for Juvenile Research at the University of Illinois at Chicago, he is director of public and community psychiatry at the university.

As a prevention-focused, public health psychiatrist, I am committed to proactively addressing the needs of patients with mental health problems. In light of this commitment, I want to bring to your attention several recent advances in prevention in psychiatry.

When Dr. David Satcher served as the 16th surgeon general, during his 2000 Conference on Children’s Mental Health, he suggested three areas of focus for mental health professionals that would lead to improving the public’s health: protective services, special education, and juvenile justice. Taking his advice, many of us have been working in these areas and gaining some ground.

Child Protective Services

More than a decade ago, some disturbing trends became apparent in downstate Illinois in McLean County. Although the statewide average of removing children from their families was 4/1,000, child protective services in that county were removing 40/1,000 children from their families.

The director of the Department of Children and Family Services (DCFS) learned about this problem and sent Community Mental Health Council (CMHC), and Urban Services, downstate to fix this problem. CMHC is a mental health center that uses evidence-based practices to serve its community in Chicago, and Urban Services is a social service agency that seeks to support communities by improving their social cohesion and control. By using a seven-field principle model that strengthened families, we were able to reduce the number of children being removed dropped from 24.1/1,000 down to 11.1/1,000.

Furthermore, follow-up studies indicated children and families in the intervention were far less likely to have subsequent hotline calls, compared with those not in the intervention. Thanks to the leadership of several subsequent DCFS directors, slowly but surely, Illinois began to infuse intact family services into their agency.

The result was Illinois was able to reduce the number of children being removed from their homes from 4/1,000 down to 1.8/1,000. Fortunately, for the nation, President Barack Obama appointed Bryan Samuels, a former DCFS directors who infused a prevention into Illinois DCFS, as the commissioner of the Administration of Children, Youth, and Families, and he is on a mission to spread what he started in Illinois to the entire nation.

Youth in Special Education

Earlier this year, I realized that fetal alcohol syndrome (FAS) was a serious contributor to the four major and common problems children have (speech and language disorders, attention-deficit/hyperactivity disorder, specific learning disorders, and mild mental retardation).

It is interesting to me how focused psychiatry is on neuropsychiatry and brain imaging, but as far as I know, there is no objective test available to diagnose FAS other than the characteristic facies with which a child with serious FAS is born but gradually outgrows, making it difficult to diagnose an adolescent or adult.

Someone once suggested that if I suspected any of the four major and common problems of children, I ask to see a baby picture to see whether I can recognize the characteristic facies of FAS. While I am more a fan of clinical medicine/psychiatry than I am of laboratory medicine/psychiatry, I wonder why our neuropsychiatric researchers have not tackled this common problem.

Regardless, the problem of FAS does seem to be on federal radar as a potentially major prevention initiative, and the Substance Abuse and Mental Health Administration is certainly aware of the problem as the agency cites fetal alcohol spectrum disorders as more common than autism. Fortunately, some states are ahead of the curve (for example, Alaska and Washington states), and there is a National Organization on Fetal Alcohol Syndrome (NOFAS). Hopefully, the observations about the huge impact that FAS makes on special education will pan out, and we will see some prevention traction in the area of special education – as we did with cretinism and phenylketonuria.

Youth in Juvenile Justice

For me, providing treatment to young people who have wound up in the juvenile justice system has been the toughest challenge, because the psychiatrist’s ability to influence such systems is minimal. However, a recent National Academy of Sciences (NAS) report – "Reforming Juvenile Justice: A Developmental Approach" – has just been released, and, if this report gains footing in the United States, we will all be much better off.

As director of the Institute for Juvenile Research (IJR) – where child psychiatry started – I am familiar with the development of the first juvenile court in the United States. It was shortly thereafter that the same group of women (led by Nobel Prize–winning social workers Jane Addams and Julia Lathrop) who developed that special court began IJR to study delinquency. It turns out more than 100 years later, we are rediscovering their wisdom as the new NAS report illustrates.

So, prevention is alive and well in psychiatry. The construct of prevention in psychiatry has even made its way beyond the specialty. Take, for example, the Wikipedia entry on mental disorders – which has a subsection on prevention.

Dr. Bell is president and chief executive officer of Community Mental Health Council Inc. in Chicago. In addition to serving as director of the Institute for Juvenile Research at the University of Illinois at Chicago, he is director of public and community psychiatry at the university.

As a prevention-focused, public health psychiatrist, I am committed to proactively addressing the needs of patients with mental health problems. In light of this commitment, I want to bring to your attention several recent advances in prevention in psychiatry.

When Dr. David Satcher served as the 16th surgeon general, during his 2000 Conference on Children’s Mental Health, he suggested three areas of focus for mental health professionals that would lead to improving the public’s health: protective services, special education, and juvenile justice. Taking his advice, many of us have been working in these areas and gaining some ground.

Child Protective Services

More than a decade ago, some disturbing trends became apparent in downstate Illinois in McLean County. Although the statewide average of removing children from their families was 4/1,000, child protective services in that county were removing 40/1,000 children from their families.

The director of the Department of Children and Family Services (DCFS) learned about this problem and sent Community Mental Health Council (CMHC), and Urban Services, downstate to fix this problem. CMHC is a mental health center that uses evidence-based practices to serve its community in Chicago, and Urban Services is a social service agency that seeks to support communities by improving their social cohesion and control. By using a seven-field principle model that strengthened families, we were able to reduce the number of children being removed dropped from 24.1/1,000 down to 11.1/1,000.

Furthermore, follow-up studies indicated children and families in the intervention were far less likely to have subsequent hotline calls, compared with those not in the intervention. Thanks to the leadership of several subsequent DCFS directors, slowly but surely, Illinois began to infuse intact family services into their agency.

The result was Illinois was able to reduce the number of children being removed from their homes from 4/1,000 down to 1.8/1,000. Fortunately, for the nation, President Barack Obama appointed Bryan Samuels, a former DCFS directors who infused a prevention into Illinois DCFS, as the commissioner of the Administration of Children, Youth, and Families, and he is on a mission to spread what he started in Illinois to the entire nation.

Youth in Special Education

Earlier this year, I realized that fetal alcohol syndrome (FAS) was a serious contributor to the four major and common problems children have (speech and language disorders, attention-deficit/hyperactivity disorder, specific learning disorders, and mild mental retardation).

It is interesting to me how focused psychiatry is on neuropsychiatry and brain imaging, but as far as I know, there is no objective test available to diagnose FAS other than the characteristic facies with which a child with serious FAS is born but gradually outgrows, making it difficult to diagnose an adolescent or adult.

Someone once suggested that if I suspected any of the four major and common problems of children, I ask to see a baby picture to see whether I can recognize the characteristic facies of FAS. While I am more a fan of clinical medicine/psychiatry than I am of laboratory medicine/psychiatry, I wonder why our neuropsychiatric researchers have not tackled this common problem.

Regardless, the problem of FAS does seem to be on federal radar as a potentially major prevention initiative, and the Substance Abuse and Mental Health Administration is certainly aware of the problem as the agency cites fetal alcohol spectrum disorders as more common than autism. Fortunately, some states are ahead of the curve (for example, Alaska and Washington states), and there is a National Organization on Fetal Alcohol Syndrome (NOFAS). Hopefully, the observations about the huge impact that FAS makes on special education will pan out, and we will see some prevention traction in the area of special education – as we did with cretinism and phenylketonuria.

Youth in Juvenile Justice

For me, providing treatment to young people who have wound up in the juvenile justice system has been the toughest challenge, because the psychiatrist’s ability to influence such systems is minimal. However, a recent National Academy of Sciences (NAS) report – "Reforming Juvenile Justice: A Developmental Approach" – has just been released, and, if this report gains footing in the United States, we will all be much better off.

As director of the Institute for Juvenile Research (IJR) – where child psychiatry started – I am familiar with the development of the first juvenile court in the United States. It was shortly thereafter that the same group of women (led by Nobel Prize–winning social workers Jane Addams and Julia Lathrop) who developed that special court began IJR to study delinquency. It turns out more than 100 years later, we are rediscovering their wisdom as the new NAS report illustrates.

So, prevention is alive and well in psychiatry. The construct of prevention in psychiatry has even made its way beyond the specialty. Take, for example, the Wikipedia entry on mental disorders – which has a subsection on prevention.

Dr. Bell is president and chief executive officer of Community Mental Health Council Inc. in Chicago. In addition to serving as director of the Institute for Juvenile Research at the University of Illinois at Chicago, he is director of public and community psychiatry at the university.

My life’s work has been about not only treating mental illness but preventing it.

That’s why on Friday, Jan. 14, the day before the birthday of Dr. Martin Luther King Jr., I resigned from the prestigious National Institute on Mental Health’s Mental Health Advisory Council. My reasoning? The NIMH spends a measly 5% of its budget on its fourth objective, which is "Strengthening the Public Health Impact of NIMH-Supported Research."

Meanwhile, the agency spends 59% of its annual funds (about $1.5 billion) on objective No. 1, "Promote Discovery in the Brain and Behavioral Sciences to Fuel Research on the Causes of Mental Disorders"; 14% on objective No. 2, "Chart Mental Illness Trajectories to Determine When, Where, and How to Intervene"; and 21% on objective No. 3, "Develop New and Better Interventions That Incorporate the Diverse Needs and Circumstances of People With Mental Illnesses."

I had been appointed to the agency’s mental health advisory council 4 years ago by the former secretary of Health and Human Services. In addition to the many other efforts with which I’ve been involved over the years on preventing mental illness, I have worked for more than 6 years on the Prevention in Action column that is published by this news service. My commitment to prevention led me to conceptualize the column, and Diana Mahoney of this news organization’s New England Bureau brings it to fruition several times a year. In other words, I believe firmly that public policy, social capital, and actual capital should be directed toward preventing psychiatric problems.

My reality is simple: The purpose of science is to discover new knowledge, and without applying that knowledge, what’s the point? The NIMH has used a lot of taxpayer money to learn a great deal about how to help people with mental disorders. Unfortunately, much of NIMH’s research does not get used to help people as mental health professionals rarely use it. To make matters worse, robust evidence shows that there are several evidence-based prevention interventions (see Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities [Washington: National Academies Press, 2009]) and treatment interventions, which, if used, could help a ton of suffering people. However, for reasons that escape me, the NIMH seems reluctant to research how to implement these prevention and treatment innovations.

I understand that the NIMH is a mental health research institute and that the Substance Abuse and Mental Health Services Administration (SAMHSA) is the implementation arm that puts innovations into practice. (Just recently, the Centers for Disease Control has begun to pay attention to mental health.) The problem is that the SAMSHA is not supposed to do research, and our nation desperately needs research on how to implement evidence-based treatments and more importantly (from a public health perspective), prevention interventions. Per its own objectives, NIMH is supposed to provide funding to do research on implementation. But, allocating 5% toward that objective is indefensible – and reprehensible.

The NIMH does not have a scientific clue about why most of its efficacious randomized, controlled trial prevention and treatment interventions are not being used. The NIMH does not have a clue about how to increase uptake of science that could help millions of people improve their lives and, potentially, never become mentally ill in the first place. I could not in good conscience sit in that room approving great research that would never be used. After all, it was the day before Dr. King’s birthday.

I regret removing my advocacy from this body. But after 3 years, it became clear to me that my concerns were being met with platitudes, as the money had not shifted toward public health. The cosmetic tokenism represented by NIMH’s public health agenda is a poor use of our tax dollars.

Dr. Bell is chief executive officer and president of Community Mental Health Council Inc. of Chicago. He also serves as acting director of the Institute of Juvenile Research at the University of Illinois at Chicago and is director of public and community psychiatry at the university. E-mail him.

My life’s work has been about not only treating mental illness but preventing it.

That’s why on Friday, Jan. 14, the day before the birthday of Dr. Martin Luther King Jr., I resigned from the prestigious National Institute on Mental Health’s Mental Health Advisory Council. My reasoning? The NIMH spends a measly 5% of its budget on its fourth objective, which is "Strengthening the Public Health Impact of NIMH-Supported Research."

Meanwhile, the agency spends 59% of its annual funds (about $1.5 billion) on objective No. 1, "Promote Discovery in the Brain and Behavioral Sciences to Fuel Research on the Causes of Mental Disorders"; 14% on objective No. 2, "Chart Mental Illness Trajectories to Determine When, Where, and How to Intervene"; and 21% on objective No. 3, "Develop New and Better Interventions That Incorporate the Diverse Needs and Circumstances of People With Mental Illnesses."

I had been appointed to the agency’s mental health advisory council 4 years ago by the former secretary of Health and Human Services. In addition to the many other efforts with which I’ve been involved over the years on preventing mental illness, I have worked for more than 6 years on the Prevention in Action column that is published by this news service. My commitment to prevention led me to conceptualize the column, and Diana Mahoney of this news organization’s New England Bureau brings it to fruition several times a year. In other words, I believe firmly that public policy, social capital, and actual capital should be directed toward preventing psychiatric problems.

My reality is simple: The purpose of science is to discover new knowledge, and without applying that knowledge, what’s the point? The NIMH has used a lot of taxpayer money to learn a great deal about how to help people with mental disorders. Unfortunately, much of NIMH’s research does not get used to help people as mental health professionals rarely use it. To make matters worse, robust evidence shows that there are several evidence-based prevention interventions (see Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities [Washington: National Academies Press, 2009]) and treatment interventions, which, if used, could help a ton of suffering people. However, for reasons that escape me, the NIMH seems reluctant to research how to implement these prevention and treatment innovations.

I understand that the NIMH is a mental health research institute and that the Substance Abuse and Mental Health Services Administration (SAMHSA) is the implementation arm that puts innovations into practice. (Just recently, the Centers for Disease Control has begun to pay attention to mental health.) The problem is that the SAMSHA is not supposed to do research, and our nation desperately needs research on how to implement evidence-based treatments and more importantly (from a public health perspective), prevention interventions. Per its own objectives, NIMH is supposed to provide funding to do research on implementation. But, allocating 5% toward that objective is indefensible – and reprehensible.

The NIMH does not have a scientific clue about why most of its efficacious randomized, controlled trial prevention and treatment interventions are not being used. The NIMH does not have a clue about how to increase uptake of science that could help millions of people improve their lives and, potentially, never become mentally ill in the first place. I could not in good conscience sit in that room approving great research that would never be used. After all, it was the day before Dr. King’s birthday.

I regret removing my advocacy from this body. But after 3 years, it became clear to me that my concerns were being met with platitudes, as the money had not shifted toward public health. The cosmetic tokenism represented by NIMH’s public health agenda is a poor use of our tax dollars.

Dr. Bell is chief executive officer and president of Community Mental Health Council Inc. of Chicago. He also serves as acting director of the Institute of Juvenile Research at the University of Illinois at Chicago and is director of public and community psychiatry at the university. E-mail him.

My life’s work has been about not only treating mental illness but preventing it.

That’s why on Friday, Jan. 14, the day before the birthday of Dr. Martin Luther King Jr., I resigned from the prestigious National Institute on Mental Health’s Mental Health Advisory Council. My reasoning? The NIMH spends a measly 5% of its budget on its fourth objective, which is "Strengthening the Public Health Impact of NIMH-Supported Research."

Meanwhile, the agency spends 59% of its annual funds (about $1.5 billion) on objective No. 1, "Promote Discovery in the Brain and Behavioral Sciences to Fuel Research on the Causes of Mental Disorders"; 14% on objective No. 2, "Chart Mental Illness Trajectories to Determine When, Where, and How to Intervene"; and 21% on objective No. 3, "Develop New and Better Interventions That Incorporate the Diverse Needs and Circumstances of People With Mental Illnesses."

I had been appointed to the agency’s mental health advisory council 4 years ago by the former secretary of Health and Human Services. In addition to the many other efforts with which I’ve been involved over the years on preventing mental illness, I have worked for more than 6 years on the Prevention in Action column that is published by this news service. My commitment to prevention led me to conceptualize the column, and Diana Mahoney of this news organization’s New England Bureau brings it to fruition several times a year. In other words, I believe firmly that public policy, social capital, and actual capital should be directed toward preventing psychiatric problems.

My reality is simple: The purpose of science is to discover new knowledge, and without applying that knowledge, what’s the point? The NIMH has used a lot of taxpayer money to learn a great deal about how to help people with mental disorders. Unfortunately, much of NIMH’s research does not get used to help people as mental health professionals rarely use it. To make matters worse, robust evidence shows that there are several evidence-based prevention interventions (see Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities [Washington: National Academies Press, 2009]) and treatment interventions, which, if used, could help a ton of suffering people. However, for reasons that escape me, the NIMH seems reluctant to research how to implement these prevention and treatment innovations.

I understand that the NIMH is a mental health research institute and that the Substance Abuse and Mental Health Services Administration (SAMHSA) is the implementation arm that puts innovations into practice. (Just recently, the Centers for Disease Control has begun to pay attention to mental health.) The problem is that the SAMSHA is not supposed to do research, and our nation desperately needs research on how to implement evidence-based treatments and more importantly (from a public health perspective), prevention interventions. Per its own objectives, NIMH is supposed to provide funding to do research on implementation. But, allocating 5% toward that objective is indefensible – and reprehensible.

The NIMH does not have a scientific clue about why most of its efficacious randomized, controlled trial prevention and treatment interventions are not being used. The NIMH does not have a clue about how to increase uptake of science that could help millions of people improve their lives and, potentially, never become mentally ill in the first place. I could not in good conscience sit in that room approving great research that would never be used. After all, it was the day before Dr. King’s birthday.

I regret removing my advocacy from this body. But after 3 years, it became clear to me that my concerns were being met with platitudes, as the money had not shifted toward public health. The cosmetic tokenism represented by NIMH’s public health agenda is a poor use of our tax dollars.

Dr. Bell is chief executive officer and president of Community Mental Health Council Inc. of Chicago. He also serves as acting director of the Institute of Juvenile Research at the University of Illinois at Chicago and is director of public and community psychiatry at the university. E-mail him.