National Alliance on Mental Illness
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APRIL 24, 1997



Chairman Porter and Members of the Subcommittee, my name is Sheila LaPolla. I am testifying today on behalf of myself and others with severe mental illnesses, as well as on behalf of our family members. We have been traumatized by these devastating heritable, chronic diseases. My hope is that research will find the answers to the mysteries of the brain so that by the time my beautiful grandson is an adult he will not be struck by one of these life-altering and life threatening diseases. For, through no fault of his own, he is at risk.

Four years ago, the dramatic onset of severe mental illness changed my life. At that time, I was diagnosed with bipolar disorder (manic depression). My deepest fear was realized. I joined the ranks of my father who had unipolar depression ( major depression), my brother who had bipolar disorder (manic-depression) and my other brother who had schizophrenia. I use the past tense when mentioning my family members because they all died victims of their diseases. I am determined not to die a victim of my bipolar disease.

I am fortunate that advances in research have led to newer treatments that have allowed me to lead a productive life. I am currently serving as a consultant to a State Senator in my home state of California. I have also been able to continue volunteer work in my community with the Sacramento Alliance for the Mentally Ill and the local chapter of the American Diabetes Association. I have also had the tremendous support of my husband of 29 years and a son, daughter-in-law and grandson.

Mr. Chairman, on behalf of all people with severe mental illnesses and their families, I would like to thank you for supporting increases in research funding these past two years. Were it not for your commitment to see that adequate resources go to research, I doubt I would be here today. As little as two weeks ago I had a manic episode. A newly researched and FDA approved antipsychotic medication helped stabilize me Without funds for the basic medical research to understand the brain, scientists could never be able to develop better medications like the one which pried me from the grip of mania.

For too long, severe mental illness has been shrouded in stigma and discrimination. These illnesses have been misunderstood, feared, hidden, and often ignored by science. Only in the last few decades have we seen the first real hope for people with severe mental illnesses through pioneering research that has uncovered both a biological basis for these brain disorders and treatments that work.

Research has proven that brain disorders are treatable. The current success rate for treating schizophrenia is 60 percent. The success rate for bipolar disorder has risen in recent years and now approaches 65 percent. For major depression, the rate has climbed to nearly 80 percent. These recent advances would not have been possible without substantial investment in biomedical research directed to the most complex organ in the human body, the brain.

The treatment of schizophrenia and schizoaffective disorder is undergoing rapid change, with the introduction of second-generation antipsychotic drugs. By 1998, clinicians will need to know which of many first and second-generation drugs to try with what type of patient. NIMH is currently proposing clinical trials to reform clinical guidelines and clinical practice. This initiative would explore the use of these new drugs for patients with various types of schizophrenia, including first-break, chronic, treatment-resistant, with comorbid substance abuse, and with associated depression. There is a similar need to assess the efficacy and patient characteristics of new anticonvulsant drugs being used for the treatment of bipolar disorder.

Advances in the development of molecular models of disease, including the creation of genetically manipulated mice (transgenic) which mimic a specific disease, have created new and exciting opportunities to understand brain development and function. Genetic technologies have progressed rapidly. The increasing ability of scientists to manipulate the mouse genome has created remarkable new scientific opportunities to understand the development of the brain, brain function, and the genetics of behavior.

One of the most important advances that resulted in the past decade has been in treatment for schizophrenia. The introduction of clozapine has helped thousands of patients with schizophrenia to leave mental hospitals, and in some cases, to return to school, hold a job, and live independently. NIMH research on the basic biology of clozapine’s action has built the foundation for understanding how this drug works in the brain.

Clozapine saves an average of $23,000 per patient annually. This translates into a total savings of approximately $1.4 billion each year; the savings are realized primarily through the reduction in the need for hospitalization. The annual costs of a new drug to treat schizophrenia is $4,500; annual hospital costs for persons with schizophrenia average $73,403. Thus, widespread use of drug therapy could save approximately $69,000 per patient annually.

NIMH sponsored research findings support proposals to reduce the frequency of blood monitoring in clozapine-treated patients, particularly after the first six months of treatment. Reducing the blood monitoring from weekly to monthly (as is now done in Europe) would save 75 percent of the cost of safety monitoring, approximately $5,000 per year per patient, resulting in cumulative savings of $225 million per year in the United States based upon the 60,000 patients currently receiving clozapine. This reduced blood monitoring also would increase the number of potential patients using the drug, some of whom currently avoid the treatment due to the weekly drawing of blood.

NIMH supported research is also offering new hope to people who suffer bipolar disorder. For some people with bipolar, also known as manic-depressive illness, lithium treatment does not work at all. For others, lithium may lose its effectiveness due to the development of tolerance or treatment interruptions. Recent NIMH clinical research have shown that two other drugs that were originally developed as anticonvulsants, carbamazepine and valproate, are effective for some manic-depressive patients who do not respond well to lithium. NIMH research aims to increase the treatment options for manic depressive illness and to learn how to target different drug therapies to the needs of individual patients.

Mr. Chairman, through your leadership in supporting increases for research at NIH and NIMH we have been able to see this rapid progress continue. As your Subcommittee was told last year by a panel of Nobel laureates, brain research offers the most tremendous potential for advances in basic science and clinical treatment. These investments will certainly prove critical in improving public health and extending life expectancy for decades to come.

According to a study by the World Health Organization, diseases such as major depression, schizophrenia, and bipolar illness currently make up about 40% of the total loss of health life due to noncommunicable disease. This figure is expected to climb to 60% by the year 2020. It is important to note that while unipolar major depression is ranked as the fourth highest costly disease in 1990, the study projects that it will become the second highest ranking disease by 2020, outranking road-traffic accidents, cancer, and infectious diseases. In addition, bipolar disorder, schizophrenia, and obsessive-compulsive disorder are all expected to climb into the top 25 diseases, making continued research on serious brain disorders a top priority.

In the U.S., severe mental illnesses account each year for more than $148 billion in direct health care costs, and indirect costs, such as lost work days for patients and care givers. In a given year, these disorders account for 25% of all federal disability payments (Social Security Insurance and Social Security Disability Insurance).

Mr. Chairman, in addition to urging the Subcommittee to support increased funding for brain research, I would also like to make note of the importance of federally funded mental illness services through the Center for Mental Health Services at SAMHSA. Federal support for community-based care is a critical resource for people with the most severe mental illnesses. With many states reducing their inpatient hospital beds and a growing number moving toward managed care systems, the federal investment in community-based care continues to grow in importance. For example, funding for the Mental Health Performance Partnership now constitutes nearly 40 percent of all non-institutional services spending in many states.

Services such as case management, crisis intervention and psychosocial rehabilitation are critical in enabling people with the most severe mental illnesses to live productive lives in the community. As you know, many programs within the CMHS budget have not received increases to account for inflation in nearly five years. Moreover, recent changes in federal law such as welfare reform and restrictions on eligibility for SSI and SSDI for people whose disability is based in part on drug abuse or alcoholism are now placing tremendous pressure on local treatment and support systems.

These programs, particularly the Mental Health Performance Partnership, PATH, Childrens’ Mental Health and Knowledge Development and Application Demonstrations, are critical to our nation’s public mental health system. Increasing funds for these programs is vital, in order to keep pace with higher demand for services and the absence of inflation adjustments over the past five years.

Mr. Chairman, thank you for the opportunity to offer my views on FY 1998 funding for programs of critical importance to people with serious brain disorders. We look forward to working with you in the coming months to educate both the general public and your colleagues in Congress on the critical importance of investment in biomedical research.