The Menninger Clinic: Ian Aitken, President & CEO

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According to the World Health Organization, depression and other neuropsychiatric disorders are the leading cause of disability worldwide and affect around 450 million people. In the United States, about 95 Americans die by suicide every day. However, despite the prevalence of mental illness, it still remains one of the most stigmatized diseases.

The Menninger Clinic, located in Houston, TX, hopes to eliminate this stigma by bringing mental health treatment into the mainstream, approaching diagnosis and treatment as you would any other disease such as heart disease. Ian Aitken, president and chief executive officer of Menninger, views research as the way to accomplish this mission.

“We now have the tools and technology that allow us to understand the brain,” he said. “A lot of stigma around the disease has been that people haven’t understood its biological origins. They thought it had something to do with their character or family. People do not appreciate it as a malfunction of an organ in the body.”

Becoming an international treatment destination

Begun in 1925, Menninger has undergone major changes to continue its position as a national leader, position it has maintained since the early 1960s in mental health treatment.  The Clinic was located in Kansas for decades, but in 2000 Aitken says the leadership began planning for the future and felt The Clinic needed a partner.

“We made the decision that the organization should find a strategic partner, preferably a major medical school,” said Aitken, who has been with Menninger since 1996. “That decision was based on our view that research would lead the field into the future, particularly neuropsychiatric research.”

The organization searched for schools and in 2003 relocated to Houston to partner with Baylor College of Medicine and its partner at the time, Methodist Hospital System. The Clinic now has 135 beds, about 350 staff members and still attracts patients from all over the country (40 percent from Texas and 60 percent from remaining states and foreign countries).

The Clinic specializes in treating patients with complex diagnoses and accompanying disorders.

“Many patients who have not responded well to treatment in their local community come to Menninger for intensive treatment,” Aitken said. “Patients usually stay between six and eight weeks, which is significantly different from most psychiatric hospitals in the country. Those have an average stay of about six days.”

The Clinic engages patients in specialty, intensive psychotherapeutic and psychobiologic treatment. “This is not a typical model of psychiatric hospitals in the United States, but it’s a model we’re familiar with and have been practicing for the last 85 years.”

Overcoming challenges

Aside from the stigma surrounding mental illness, funding issues create significant challenges for Menninger. “I don’t think there is a clear agreement between provider and payer communities as to what constitutes effective care,” Aitken said. “We all agree we’d like to deliver value to patients, but how we assign value is always a point of contention.”

Most payers will cover a short stay at an acute care facility, but may not always pay for the longer, intensive care provided at Menninger. Providing longitudinal data of the effectiveness of treatment plays a large role in changing the payer perspective. Menninger has begun taking steps to track outcomes in patients.

“As patients leave Menninger, many go to other treatment providers to continue honing the management of their illness. Although they only stay at Menninger six to eight weeks, we need to know two years down the road that the investment they made produces long-lasting results,” he said. “We are in the third year of an outcome project we’ve created here to do just that.

There are a variety of environmental issues that affect a patient’s ability to sustain recovery. It is a difficult set of variables to manage to track effectiveness over time. And then to convince others who have an interest in that.”

Continuing the mission

While tracking outcomes, Menninger has begun implementing big plans for the future. Aitken says Menninger has purchased land and is planning to create a “mental health epicenter,” making the Houston facility a national destination for research, treatment and education. Aitken describes three elements to this plan: attracting the finest researchers and students, collaborating for more effective research, treatment and prevention, and capitalizing on mental health and medical professionals working side by side.

“We would like to try to create public/private collaborations with mental health organizations in Houston and Texas so that we can turn the public system of care into something more effective than it presently is,” he said.

Over the past few years, Menninger has initiated some community-based programs to help improve the quality of care to people locally. “We are taking a leadership role in the community and working with those individuals who are serving in it every day. We need to measure ourselves in how we are able to help the community’s most disabled members,” he said.

Aitken is looking forward to the future and seeing some hope in improving the understanding of mental illness through research and technological advances. “I think people are starting to view mental illness as a treatable disease,” he said. “A lot of patients are starting to understand they can recover. I believe the future is very bright.”

-by Patricia Chaney

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