About
Background - The Idea
Addressing A Need
The Plan
Getting People Involved
The NNDC and Beyond
Background - The Idea
The historical development of the national network of cancer centers provides a roadmap for starting a national network of depression centers (NCI Cancer Bulletin, March 15, 2005, Volume 2, No.11).
In 1960, the National Cancer Institute (NCI) began providing grants to cancer-focused interdisciplinary centers that had already been created with state or private funds, upon the recommendation of the NIH Task Force on Categorical Research Centers. In 1971, President Nixon signed the National Cancer Act, authorizing $1.5 billion for a National Cancer Program and the establishment of 15 new NCI-designated Cancer Centers. The original intent of Congress was to have a center within 200 miles of every U.S. resident, enhancing the application of cancer discoveries to patients and people at risk.
“The National Cancer Institute should closely study the use of cancer research centers for it is here that many impressive research findings are being and will be uncovered. It is also here that the effectiveness of these findings can be proved.”
The National Cancer Act of 1971 (P.L. 92-218)
In 1973, eight NCI-designated Cancer Centers were categorized as “comprehensive,” according to criteria established by the National Cancer Advisory Board (NCAB). In 1975, the Senate endorsed the establishment of 30 – 35 NCI-designated Comprehensive Cancer Centers to permit an estimated 80 percent of the U.S. population access within a reasonable driving distance. The current distribution of Comprehensive Cancer Centers is shown below.
There are approximately 35 additional Centers in the country that are not designated as “Comprehensive.”
In theory, any institution that conducts cancer research can apply to become an NCI Center, but as stated by Dr. Linda Weiss, Chief, NCI’s Cancer Center Branch, “the requirements are steep: a large cancer-relevant grant funding base; substantial institutional commitment in the form of space, resources, and authorities provided to the Center director; organization of transdisciplinary research across all scientific areas of the institution to ‘make the whole greater than the sum of its parts;’ and, specifically for comprehensive centers, community outreach, education, and training activities. The average NCI grant base for existing centers is somewhere around $11 million…” (NCI Cancer Bulletin, March 15, 2005, Volume 2, No.11). Dr. Weiss also expressed her view that perhaps the major advantages of Cancer Centers is that they “have an environment that fosters basic discovery and its translation into cancer treatment, prevention, and control activities; and the ability to network both within their community and with each other, so there’s extraordinary research power.” The NCI Cancer Center network has also become a powerful voice for continuing support. The growth pattern is impressive.
These same advantages are now needed to attack depression and bipolar illnesses.
Addressing A Need
The time has come to fight more effectively against depressive and bipolar illnesses by creating a national network of depression centers. Experts have told us for years that depression and bipolar illness (manic-depression) affect at least one of every five Americans and are the leading causes of disability in the world. Hundreds of studies explain why depressive illnesses are underdiagnosed and undertreated; why depression ranks second only to heart diseases as the most expensive contributor to our soaring health care costs; why depression costs have contributed disproportionately to our current automobile crisis; why suicide tragically extinguishes 30,000 lives each year and has become the third most frequent cause of death among teenagers; and why stigma remains a potent barrier for the 19 million Americans with these disorders.
We don’t need more elaborations about “why.” We need a response proven to work.
The Plan
What will work is to copy the successful strategy developed by cancer and cardiovascular specialists several decades ago—establishing centers of excellence. In 1954, for example, childhood leukemia victims survived an average of only three months. Now—following clinical procedures developed in cancer centers—more than 80% are cured. It is not surprising that Dr. John E. Niederhuber, current Director of the National Cancer Institute (NCI), states that “The cancer centers have been and continue to be the crown jewels of the NCI’s program” (The New York Times, August 17, 2006). Cardiovascular Centers just as dramatically reduced death rates from heart disease by one-half. Centers do this by linking strong academic institutions with community clinicians, translating brilliant research into clinical breakthroughs, and conducting education and public policy programs for everyone. Their networks enable experts to share their knowledge and more rapidly translate new advances into practice. And Centers fight stigma, simply by being honest with their choice of names.
That last observation about fighting stigma is best illustrated by cancer’s history. In the late 1960s, discussions about cancer often occurred in whispers. References to “The Big ‘C’” were the norm. Cancer Centers showed us a different way by proudly displaying their names. We now have more than 70 Centers across the country’s landscape proudly displaying their names. During the same time frame, depressive and bipolar illnesses—statistically more burdensome and expensive than cancers—remained too preoccupied with being hidden and secretive. Stigma continued its momentum while philanthropy and research lagged. That strategy for fighting stigma hasn’t worked, so the University of Michigan Depression Center and other academic centers across the nation have sought to change that by acknowledging “Depression” in program and facility names, and bringing the discussion of depression and bipolar disorders to the forefront.
Let us learn from our cancer and cardiovascular colleagues about the benefits of promoting an integrated network. National Institute of Health (NIH) participation will be necessary to insure a strong research foundation, and attaining the support necessary will take time and leadership so we need to get started. America desperately needs better strategies to attack depression and bipolar illnesses. A national network of centers of excellence is a model proven to have impact. The time has come to establish a national network of depression centers.
Getting People Involved
The National Network of Depression Centers (NNDC) is an initiative being launched by the University of Michigan Comprehensive Depression Center, in conjunction with colleague institutions across the nation. The primary goal of the NNDC is to transform and accelerate the understanding and treatment of depressive and bipolar disorders by developing an integrated network of leading Depression Centers. The multidisciplinary outreach programs of the NNDC will help to better diagnose and treat depression and bipolar illness, as well as eradicate stigma associated with these diseases.
The NNDC and Beyond
On April 20, 2007 an initial organizing meeting for the NNDC was held at the University of Michigan Depression Center. This meeting was attended by representatives from 15 other eminent academic medical centers. These centers finalized their commitment to participate in a year-long exploratory foundation phase for the NNDC. During this phase, the charter group will:
- Develop subcommittees to establish NNDC policy in particular areas
- Establish network guidelines
- Determine the organizational structure
- Establish direction and goals for the management team
- Adopt an educational message and objectives
Scheduled to come together once again for a Charter Signing Ceremony in 2008, these various institutions will be given the unique opportunity to ‘make history’; establishing the NNDC as an independent nonprofit and the first network of its kind. These institutions will join forces, synergizing resources and work together towards achieving the same goals: develop and implement new approaches to detect depression and bipolar disorders early, treat more effectively to achieve wellness, prevent recurrences, counteract stigma and transform public policy.
The National Network of Depression Center mission statement is:
To improve the quality, effectiveness, and availability of depression and bipolar diagnosis, treatment, and prevention so people can live better lives.
