Executive Summary
The time has come to fight more effectively against depressive and bipolar illnesses by creating a national network of depression centers. Experts have told us for years that depression and bipolar illness (manic-depression) affect at least one of every five Americans and are the leading causes of disability in the world. Hundreds of studies explain why depressive illnesses are underdiagnosed and undertreated; why depression ranks second only to heart diseases as the most expensive contributor to our soaring health care costs; why depression costs have contributed disproportionately to our current automobile crisis; why suicide tragically extinguishes 30,000 lives each year and has become the third most frequent cause of death among teenagers; and why stigma remains a potent barrier for the 19 million Americans with these disorders.
We don’t need more elaborations about “why.” We need a response proven to work.
What will work is to copy the successful strategy developed by cancer and cardiovascular specialists several decades ago—establishing centers of excellence. In 1954, for example, childhood leukemia victims survived an average of only three months. Now—following clinical procedures developed in cancer centers—more than 80% are cured. It is not surprising that Dr. John E. Niederhuber, current Director of the National Cancer Institute (NCI), states that “The cancer centers have been and continue to be the crown jewels of the NCI’s program” (The New York Times, August 17, 2006). Cardiovascular Centers just as dramatically reduced death rates from heart disease by one-half. Centers do this by linking strong academic institutions with community clinicians, translating brilliant research into clinical breakthroughs, and conducting education and public policy programs for everyone. Their networks enable experts to share their knowledge and more rapidly translate new advances into practice. And Centers fight stigma, simply by being honest with their choice of names.
That last observation about fighting stigma is best illustrated by cancer’s history. In the late 1960s, discussions about cancer often occurred in whispers. References to “The Big ‘C’” were the norm. Cancer Centers showed us a different way by proudly displaying their names. We now have more than 70 Centers across the country’s landscape proudly displaying their names. During the same time frame, depressive and bipolar illnesses—statistically more burdensome and expensive than cancers—remained too preoccupied with being hidden and secretive. Stigma continued its momentum while philanthropy and research lagged. That strategy for fighting stigma hasn’t worked, so the University of Michigan Depression Center and other academic centers across the nation have sought to change that by acknowledging “Depression” in program and facility names, and bringing the discussion of depression and bipolar disorders to the forefront.
Let us learn from our cancer and cardiovascular colleagues about the benefits of promoting an integrated network. National Institute of Health (NIH) participation will be necessary to insure a strong research foundation, and attaining the support necessary will take time and leadership so we need to get started. America desperately needs better strategies to attack depression and bipolar illnesses. A national network of centers of excellence is a model proven to have impact. The time has come to establish a national network of depression centers.