INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, VOL. 3: 155-156 (1988)

EDITORIAL

The Geriatric Mental Health Academic Award Program

A series of articles appear together in this issue on the theme of depression in the elderly. A variety of issues are covered and there is nothing to suggest a unifying influence other than the general topic. Yet, the process of assembling these articles was no accident: it was determined by relationships among the authors. The authors meet once a month as a discussion group on matters of the mental health of the elderly; the history of this group offers one view of the growth and growing pains of geriatric psychiatry in the USA.

In 1983, the National Institute of Mental Health recognized the need for a concerted effort to stimulate clinical research in the area of geriatric mental health (National Institute of Mental Health, 1987). Dr Gene Cohen, then Director of the Program on Aging, reports that the Institute was impressed and disconcerted by the discrepancy between the looming size of the public health problem and the small number of investigators who where equipped to improve the relevant knowledge base, act as teachers and prestigious role models for others and become a resource to their host institu- tions (personal communication, 1988). Simply increasing research funding in this area was not turning out to be sufficient; the Geriatric Mental Health Academic Award (GMHAA) was thus est- ablished to ‘assist in the development of academical- ly situated persons who are oriented toward re- search on the mental disorders of the aging’, including psychiatrists and nurses. Each award provides a major proportion of the candidate’s salary and some modest funds for research activities for three years, during which candidates experience a supervised individually tailored curriculum in their own institution.

Candidates are also encouraged to seek consulta- tive advice outside of their home base: which is how this group came to be formed, starting with two awardees and their external consultant and growing over a period of four years to 10 members from eight academic institutions in the northeast region of the country. There are eight psychiatrists and one

nurse; and a physician with an analogous award from the National Institute of Aging. This is not a society (though it is graced with the name Inter University Consortium of Academic Psychiatry), there are no officers and no dues. An academic award is the only requirement for admission.

Most of the members have reached the end of their awards. For some, participation requires long hours of traveling. All have heavy clinical, teaching or research schedules to manage. Yet no-one has yet dropped out. That such a group continues to serve a perceived purpose is probably a reflection on the state of development of scientific and service activities in the field of mental health of the elderly.

There are an adequate number of large formal organizations convening professionals in geronto- logy and geriatric psychiatry either as specialist societies or mainstream (generic) societies with specialist sections; these do not provide the continuing intellectual stimulus that can be obtained from a small informal group. There are still too few professionals devoted to academic issues in geriatric mental health for supportive intellectual exchanges to regularly occur within a single institution’s boundaries. Moreover, the administrative status of those in geriatric mental health is only slowly rising into the senior ranks, where confident and independent authority can be wielded and substantial resources commanded. The issues concerning understanding of the elderly with mental health problems and improvement of their care, as well as delivery of state of the art geriatric mental care, have a fairly low priority and dis- tinction in academic circles in general. Probably, these are important reasons why this group of professionals has continued its commitment to joint activities.

Another feature of this group which acts to draw its members together is the range of interests it encompasses. Many in this field would agree that multidisciplinary approaches are productive in care and research; this was a basic tenet of the GMHAA program. Yet there is surprisingly little opportunity

8 1988 by John Wiley & Sons, Ltd.

156 EDITORIAL

for such engagement with peers (as opposed to hierarchical relationships with team members from multiple disciplines). Psychiatrists in this group have discovered that even their psychiatric col- leagues bring to the table concepts stemming from disparate disciplines (such as sociology or biology, laboratory or clinical science, or public health), as of course do the physician and the nurse (who is trained as an anthropologist).

The monthly discussion sessions last up to two hours and are free-ranging. The main organizing themes over the years have included: (1) The stages of forming an academic career around the mental health of the elderly. This involved interviewing key figures in gerontology and reporting on the development of their ideas and careers. (2) Defining criteria for psychiatric diagnoses that are age-fair. (3) Presenting a one-day symposium on The Organ- ization of Mental Health Services for the Elderly; the proceedings were published.* (4) Accepting a mandate (currently active) from the New York State Health Research Council to identify the directions of needed research on indicators of quality of care and life with reference to the concerns of regulators, third-party payers, advo- cates, consumers, and program evaluators. (5) Suggesting opportunities for further research on the nature and treatment of depression in the elderly. This latter effort has produced the articles that appear in this issue of the Journal.

According to Dr Barry Liebowitz, Chief of the Mental Disorders of the Aging Research Branch at the National Institute of Mental Health (personal communication, 1988), 25 GMHH awards have been made to date, 17 to psychiatrists and eight to nurses. The energy and creativity of the awardees has been outstanding: between them they have submitted 48 research or demonstration grant applications which have been approved or are currently under review.

The group’s articles which are published in this issue speak for themselves, for better or worse. Seen as a whole they indicate the kind of issues on the topic of depression that hold the attention of this American group with a strong interest in research into the mental health problems of the elderly, and the way the group members think about useful directions for research. They reflect the influence of the GMHHA program, which can be judged accordingly.

BARRY GURLAND

REFERENCE

National Institute of Mental Health (1987) Program Announcement on the Geriatric Mental Health Academic Award, November.

* A multiauthored chapter with the above title is in press in a book Essentiulsof Geriatric Psychiutry(L. Lazarus Ed). Springer, New York.