- DR. RICHARD SMITH: Says PRI will help meet the state's 'huge' need for mental health care.
The University of Arkansas for Medical Sciences is adding to its eye, spine, the elderly and cancer focuses an emphasis on the mind.
In December, the stand-alone $32 million Psychiatric Research Institute opens its doors in a building adjacent to UAMS' new hospital tower under construction. The new “center of excellence,” as UAMS refers to the programs, will create 40 psychiatric beds, the first at UAMS in 30 years, and grow UAMS' staff by 60.
Chancellor I. Dodd Wilson credits psychiatry department chair Dr. Richard Smith with the vision to make PRI a reality. Smith says the $32 million, 110,000-square-foot facility took Wilson's “persistence” and “great leadership” to come into being. Medical Director Dr. Jeffrey Clothier commends Wilson, Smith and the philanthropic efforts of UAMS' Friends of Psychiatry. “People wrote checks,” Clothier said. “The level of family support is unprecedented.”
A host of clinicians, researchers, interns, nurses and other mental health professionals will eventually make PRI's reputation. When it opens Dec. 8, a community now scattered at offices all over town will have taken up residence under one roof.
Unlike some areas of medicine, a psychiatric research facility is unlikely to be a money-maker. Even the chancellor said he believes operating the institute “is always going to be a bit of a struggle for UAMS.” But, Wilson added, “It's also going to be this wonderful thing for the state of Arkansas. That's what we're about.”
Arkansas's mental health needs are “huge,” Smith said. Some 1,400 patients are seen every day in public clinics in Little Rock and North Little Rock. Fortunately, the university's teaching is strong and the discipline, he said, is “making dramatic strides.” UAMS graduated the third highest number of doctors going into psychiatry in the nation last year, both in number and as a percentage of the class. Smith said psychiatry has been referred to as “the last frontier” in medicine, and PRI will put UAMS there.
At UAMS psychiatric research falls less in the realm of brain biochemistry and more on behavior and what treatments work in the real world. Smith created its Division of Health Services Research in 1989; recent studies coming out of that division have looked at a wide variety of mental health issues — such as the effectiveness of treatments for post-traumatic stress disorder, how the HIV risk is understood in rural areas, managing alcohol abuse among the elderly, beliefs about depression among veterans, methamphetamine use in the South. UAMS' Center for Addiction Research, to be located in PRI's Dierks Research Laboratory, is already “world class,” medical director Clothier says. Headed up by Warren K. Bickel, a PhD, it brings in $5 million a year in federal research dollars. Bickel says the center operates “in a very fertile environment” — that is, in a state with a large population of addicts and an institution willing to invest in research to treat them.
PRI will have a number of firsts: Ten of its beds will be dedicated to patients with medical conditions, a dual diagnosis that presents a challenge in hospitals. It will house the state's first residential treatment for people with eating disorders, a service that contrasts with the some $40,000 a month Arkansans now pay in private hospitals out of state. Ten beds will be devoted to the care of very young children, a population whose number rises in tandem with poverty, drug addiction and societal pressures. Ten acute care beds will serve adults; another 10 are for geriatric patients. While they won't solve the shortage of psych beds in Arkansas — Clothier said patients practically “have to have a gun cocked and loaded” to get one — they'll help.
Researchers will have at the ready a $3 million 3-Tesla fMRI (functional magnetic resonance imaging) so they can “see the brain at work,” Smith said. The fMRI is housed in its own building, built with a $1.5 million gift from an anonymous donor.
On a tour of the PRI building recently, Smith noted its tall glass facade and open atrium. It is more than aesthetic, he said; it is symbolic of letting in light on mental illness and throwing off the stigma.
The wide design of the staircases was deliberate, Smith said, a way to promote collaboration between the professionals. The Walker Family Clinic on the second floor, which will serve both children and adults, is open to the atrium as well. A healing garden — to be landscaped by P. Allen Smith when funds are secured — is located off a dining area, surrounded by high walls for security. A huge area will serve the Health Services unit's epidemiologists, economists, statisticians and other researchers. Quiet rooms with walls of double-paned glass and bullet proof windows make the corners of the building; patients' rooms are painted in a pale seafoam green. The top floor is fitted out with an ECT (electroconvulsive therapy) machine for the treatment of major depression.
The Fred and Louise Dierks Research Laboratories will include UAMS' methadone clinic, currently located in a building near the campus, and space for the Center for Addiction Research. That research includes studies into which medications work and how, adolescent substance abuse, and how addiction influences decision-making. In his research of heroin addicts, Bickel has found that while non-addicted persons can envision the future, addicts can't think beyond the next nine days. Their focus is on meeting their most basic needs — and how to get more drug. The decision-making part of the brain — the prefrontal cortex — is “not operating on all cylinders.” Bickel hopes to relate this research to other addictions as well, including food.
Fortunately for UAMS, department chair Smith could see the future. Chancellor Wilson said a psychiatric center has been on Smith's mind for eight years. It opens Dec. 8.