The United States’ mental health crisis—marked by increasing rates of depression and suicide among youth, serious mental illness among adults, and substance use disorder among all ages and demographics—costs Americans an estimated $282 billion every year, according to a recent Yale University study.
The human cost of the crisis impacts families across the nation, and Alabama is no exception. One in four Alabamians will develop a mental illness or substance abuse issue during their lives; of that population, approximately 900 individuals die by suicide annually.
The UAB Psychiatry Early Intervention Program is designed and guided by Adrienne C. Lahti, M.D., chair of the Department of Psychiatry and Behavioral Neurobiology and Heman E. Drummond Endowed Chair of Psychiatry, and Matthew Macaluso, D.O., vice chair for clinical affairs and clinical director of the UAB Depression and Suicide Center. It is a novel, dynamic effort to reverse these negative trends by treating a wide range of mental disorders as soon as they arise in young patients. And in the span of only four months, community partners have raised more than $3.9 million to invest in this vital initiative.
Rapid Response
“All mental illness really starts during late adolescence and early adulthood,” said Lahti, whose successful First Episode Psychosis Program, created more than a decade ago, provided the model for the Early Intervention Program. “This is a critical period where people express symptoms of mental illness for the first time. The key thing to understand is that the longer you wait to treat—or treat adequately—the worse the likelihood of a good outcome becomes.”
The Early Intervention Program launched in July with the establishment of a First Episode Mood Disorders Clinic, which matches child, adolescent, and young adult patients with multi-professional teams of psychiatrists, child psychiatrists, social workers, and psychologists, as well as navigators trained to support families and prevent patients from falling through the cracks.
In a nation where the average duration of untreated psychosis is 14 months, early and consistent intervention can mean the difference between a healthy adulthood and an increased risk for serious—and increasingly severe—mental illness. The Early Intervention Program aims to treat patients rapidly and to provide care on an as-needed basis.
“You are not going to be able to stabilize a young person who goes through a first episode by seeing them every three months,” Lahti said.
Next year, the program will expand to address substance use disorders. “As we scale and grow the program, we want to understand the community need,” Macaluso said, emphasizing the program’s community outreach efforts in schools and libraries and continuing education opportunities for Alabama’s primary care physicians. “We envision a state-wide network of clinics, emergency rooms, and other places where patients seek help during a first episode of a mood problem, psychosis, substance use, anxiety, etc. A network that would be able to refer to us, that we could educate, that we could be a resource to when they have a need.”
Along the way, researchers will collect data to evaluate the effectiveness of different medications—avoiding a “one size fits all” approach—as well as biomarkers that can be used to inform innovative treatments in the future. According to Lahti, the program will also serve as an invaluable training opportunity for early career physicians focusing on child and adolescent psychiatric care, “educating the next generation of providers about what is most important.”
Community Support
For Rev. Gates Shaw, perhaps UAB Psychiatry’s most ardent advocate in the community, what’s most important is expanding and sustaining access to care.
“Every family has an experience of depression or addiction,” Shaw said. “And they’re first cousins: addiction, so often, is an attempt to medicate someone’s mood disorders, to alleviate it, and then it ends up in a kind of depression that compounds the mood disorder. One in five American families knows this, one way or another—whether they fully face it, or it’s just present as a major stumbling block that everybody’s dancing around.”
Shaw has worked closely with Lahti, Macaluso, and other UAB faculty and staff to rally community support around the Early Intervention Program, raising funds to build capacity and meet the state’s need for rapid, personalized mental health care. Together with his wife Margot, Shaw has spearheaded a private philanthropic campaign on behalf of the program, highlighted by a major gift from the Shaws themselves.
A key factor in the campaign’s success is the Episcopalian pastor’s candor about his own lifelong struggles with depression.
“The voice of depression is a master of degradation and depredation. And the terrible thing is, you learn to believe it because you think it,” Shaw said. “Somebody can call you a bad person, but that doesn’t convict you that you’re a bad person. Depression convicts you that you’re a bad person, or that you fall short of what you ought to be. Criticism doesn’t do that. Internalized criticism is relentless, and it has all the power once it’s gotten its foothold.”
Supporters who have been engaged in the campaign by Shaw and others see the Early Intervention Program as a strategic investment in the health and well-being of Birmingham and beyond.
“We’re very interested in the operating model that UAB has developed in terms of addressing mental health and mood disorders,” said donor Claude Nielsen. “What is really intriguing to us is the process that they’ve designed to be replicable, to be scalable. As we experience success expanding access to effective treatment in Birmingham, it can then be replicated in other communities. We are optimistic the operating model will work.”
With the support of dedicated community partners like the Shaws, the Early Intervention Program is positioned to lead the way in addressing the mental health crisis not only in Alabama, but in the United States.
“There’s hope for mental illness,” Lahti said. “We need to treat it early, and we have to do better in the state of Alabama. We have to work together to get the crisis managed.”
For more information on the UAB Psychiatry Early Intervention Program and how you can help, please contact Morgan Quarles, Director of Development, at (205) 934-9302 or
