An innovative and successful program linking state mental health centers and academic departments of psychiatry became inactive at the end of its current funding cycle in October.

The State-University Interdisciplinary Collaboration Project (SUICP), established in 1989, has united key personnel from mental health institutions and university departments to improve care for patients with serious mental illness treated largely in the public sector. The project is a joint effort of APA and the federal Center for Mental Health Services (CMHS) and was funded by CMHS for the last three years.

For a decade the project sponsored regional workshops that brought together a cross-discipline collection of individuals who brainstormed solutions to problems in the field.

A recent workshop in Atlanta, for example, convened local teachers, personnel from the juvenile justice system, and mental health personnel at the state and academic levels to tackle the issues of school-based mental health programs, juvenile justice, and treatment of children and adolescents with mental illness. Said project director James Thompson, M.D., director of the APA Division of Education, Minority, and National Programs, "We have been overwhelmed with interest from the states and universities, as well as those from the juvenile justice systems and the schools, to get together and solve these problems"—problems that are not easily overcome. For example, from 1997 to 1998, according to the National Center for Education Statistics, there were 47 school-related homicides. And data from the Substance Abuse and Mental Health Services Administration show that 9 percent of adolescents aged 12 to 17 reported use of illicit drugs in 1999.

Another project addressed a crisis facing the mental health service delivery system in California—the dire shortage of professionals working in the mental health field. The SUICP addressed recruitment and retention strategies, as well as expanded workforce roles in its large conference, whose attendees included the California Mental Health Planning Council.

Chair of the SUICP steering committee and APA past president John Talbott, M.D., helped to originate the project and has seen a great deal of productivity over the years. "We have established numerous lasting collaborations and have educated hundreds of people from all disciplines, including patients and family members," Talbott said.

The on-site consultations added a practical, hands-on component to the project, said Thompson. After a workshop, certain states would request help with strategizing and problem solving. "The project responded by sending someone from a state agency and a psychiatrist from a university medical school affiliated with SUICP to problem solve and strategize on-site."

At the heart of the project, however, were the collaborations. Talbott noted that many people from the university and public systems were virtual strangers to one another before participating in the workshops and consultations. During the face-to-face meetings, however, erroneous preconceptions were cast away and the foundations for lasting collaborations were built, he said.

"The state mental health authorities may have felt that the academic sector was aloof and had not focused research efforts on the sicker populations being treated in the public sector. But they saw that the academic people had a different mission, and were struggling under the same bureaucratic and economic constraints as [the state personnel] were," Talbott said. "There was a sharing of pain, experiences, and wishes—a breaking down of the mistrust."

Talbott explained that there was a similar breakthrough for the university personnel, who may have held misconceptions that the psychiatrists in the public sector weren’t skilled enough or couldn’t pass muster. "The university folks found that this wasn’t true and sometimes added psychiatrists from the state level to their faculties—they had good experiences collaborating [with state personnel] in research, training, and clinical services."

While the collaborations were mutually beneficial, it proved difficult to foster them over the years continually, one reason being high turnover among key participants. In the beginning of the project, Talbott did not predict that the average tenure of mental health commissioners and academic chairs in psychiatry would last approximately three and a half years. In some cases, due to the frequent staff changes, either the state or the university representatives returned for consultations more than once with psychiatrists who understood a particular state’s mental health department in order to reeducate new employees.

The program was headed by a steering committee that had evolved into a multidisciplinary group consisting at one time or another of psychiatrists, psychologists, social workers, nurses, patient advocates, families, and patients. The steering committee typically chose the consultants for the on-site consultations, and many times members served as the consultants themselves. In addition to APA, groups represented on the steering committee have included the American Academy of Child and Adolescent Psychiatry, American Nurses Association, and Mental Health America.

While the SUICP project officially began in 1989, efforts that gave rise to the project began in the late 1970s. At that time there was an attempt at collaboration between the American Association of Chairmen of Departments of Psychiatry (AACDP) and the National Association of State Mental Health Program Directors (NASMHPD). In 1980, APA organized a conference on recruitment and manpower in psychiatry, and conference leaders made suggestions to improve state and university relations in several key areas. Representatives from several leadership organizations including NASMHPD and AACDP eventually became known as the Consortium and worked to improve care for patients in the public sector.

In 1984 then-APA president Talbott and the APA Committee on the Chronically Mentally Ill convened a group to discuss the improved staffing, training, and programming in the public psychiatric hospitals. In May 1984 nearly 100 people from state mental health agencies and facilities and from academic institutions came together to speak about the successes and failures of more than 50 years of collaborations. From the discussion came a statement of action, and this resulted in the book Working Together: State-University Collaboration in Mental Health, edited by Talbott and Carolyn Robinowitz, M.D., who was the director of APA’s Office of Education. It wasn’t until June 1989 that Pew Charitable Trusts provided a grant to support a program, which was then centered on improving recruitment and retention of psychiatrists in the public sector. The CMHS was able to provide funding beginning in 1997, and this cycle ended in late October and has not been renewed.

But Talbott is optimistic about potential funding sources. "This funding cycle is over and we are again looking for funding elsewhere," he commented. "We always do tend to find the funding eventually, and we will again."