When he came on board at the Austen Riggs Center, a psychiatric hospital and residential treatment program in Stockbridge, Mass., as medical director and CEO two years ago, Andrew J. Gerber, M.D., Ph.D., had big plans for the nearly 100-year-old facility.
Coming from a post at Columbia University Medical Center’s Department of Psychiatry where he was the director of the MRI Research Program, Gerber was ready to move from a research setting to one where he had greater opportunity to put some of his work into practice both within the hospital and beyond its grounds. Gerber has begun to steer the organization in a new direction, one that he hopes will continue to bear fruit for decades or longer.
In a conversation with New England Psychologist’s Catherine Robertson Souter, Gerber spoke about his plans for the hospital and how those plans are designed to affect its future and the future of mental health care.
Q: What drew you to join the team at Austen Riggs?
A: The opportunity arose to take some of the ideas that I had both clinically and research-wise and translate them from the smaller setting of my lab at Columbia to a nationally known clinical setting working with complex psychiatric illness. That is not an opportunity in psychiatry that comes along frequently so I jumped at it.
It was also an opportunity to influence or create the latest direction for Austen Riggs along two lines I feel passionately about. One area is branching out and serving the community and the other is using research as a way to disseminate what we know and to improve what we do.
Q: How does that happen?
A: First, I believe one has to act locally in order to have a global influence so we are talking with our community to learn about their needs and how we can potentially help.
The second is to introduce empirical research to Austen Riggs that is part and parcel of delivering services while constantly studying what you deliver and how you deliver it and how to make it better.
Q: What types of research are you planning to conduct?
A: One of my particular interests has been in using developing technologies to better understand changes in the brain. We have known for a long time that experience can change the brain but we have not had the technology to actually measure that.
That has started to change over the last 20 years with the advent of the MRI. Then, in the last five years, thanks to the Human Connectome Project led by the National Institute of Mental Health, we now have a standardized method for gathering MRI data and comparing them to a database of over 1,000 brain images.
This database gives us the opportunity here at Austen Riggs to study people with complex psychopathology and compare them to the national standard to get a sense of how to categorize complex psychopathology.
A number of us believe that the traditional categorization that we use in the DSM for identifying diagnoses is useful descriptively but, in terms of understanding brain problems, the lines of division are much different. What we call autism or schizophrenia are probably composed of many different things.
We hope not to duplicate the diagnosis system we already have but to learn about new ways to classify mental problems.
Q: MRI could change the way we look at mental health diagnoses.
A: We are not currently at a stage where brain imaging is particularly useful for the vast majority of psychiatric disorders. No one knows when that will change. Is that 10 years away, 20, 30 or 50? The truth is we don’t know. When it comes, and it will come eventually, it will be a major step forward.
Q: Would we also want to have some reasonable way of treating according to the brain scan rather than treating by symptoms?
A: The treatment may not change, in fact. Existing treatments, which don’t seem “brain savvy,” actually have direct brain effects. Part of my work I did at Columbia was looking at changes in the brain in response to psychotherapy which seems old school, sitting in two chairs and talking to someone, but it is very demonstrable you are making changes in the brain over time.
Q: What other research are you looking to bring to Austen Riggs?
A: Another one is translating some of the ways we look at patients at Austen Riggs to parents and their young children in our local community. So, this past weekend we had a training in something called the NBO or newborn behavioral observation method, basically teaching nurses and other health care workers to show a mother the early strengths and vulnerabilities of her baby.
We are going to be studying the effect of adding NBO to our local hospital. The basic principle is getting parents to be tuned in to looking for and supporting the differences in their children.
Q: You are also introducing a system to track suicidal thoughts and ideation within your clientele at Austen Riggs. How will this help identify triggers?
A: It is one thing to ask someone to tell about their last day. What they say will be very selective but if they are recording it in the moment, you can get a real-time depiction of the ups and downs of an average day. We have just started piloting this with patients in order to understand what things in daily lives increase or decrease suicidal ideation.
Q: Working in a private psychiatric hospital, what are the issues you see most of which we should be more aware?
A: The one that comes to mind is really a public policy and public healthcare issue. Even as we learn new things about various aspects of mental illness, our healthcare system in this country is tragically fractured. There is no mainstream funding for long-term residential care of people with complex psychopathology and that is a tragedy. A large number of people with complex illness get treated only when they are in crisis and end up in an emergency room or, sadder, in jail. The largest mental health provider in this country is the LA County Jail.
At Austen Riggs, we are starting to get involved with policy discussion. Clearly, we need more funding but even before that is to increase awareness. I am always surprised when family members of our patients, very informed people, don’t know the sorry state of the mental health system in our country. We need to get the word out to let them know there is a crisis here.
Q: You have a lot of big and important plans for your tenure there.
A: We are at a crucial junction for Austen Riggs. This place has been around a long time and the fact we have not been sucked in to trends to focus on one treatment over another gives us a unique perspective and we have something to offer in the discussion right now.
I hope we can be a catalyzing force. I think we have a real opportunity and a real responsibility to do this.
By Catherine Robertson Souter