Tansella, Michele (1942-2015)

Michele Tansella, one of the leading psychiatrists of his age, and the Founding Editor of Epidemiology and Psychiatric Sciences (EPS), died in the Spring of 2015. He will be remembered as a leading figure in the fields of community mental health, psychiatric epidemiology, and mental health services research.

He was born in 1942 in Bari in Southern Italy and took from his parents his profound generosity of spirit, his indomitable drive and his unerring eye for detail that were to prove so important throughout his life. He completed his training in Medicine at the University of Bari in 1966, followed there by his specialisation in Nervous and Mental Diseases in 1969. He then undertook a period of research on benzodiazepines at the Institute of Psychiatry (IoP) in London with Professor Malcolm Lader. His research interests widened and he came into contact with Professor Michael Shepherd, the head of the General Practice Research Unit, from whom he learned the approach best described as ‘creative scepticism’, steeped in the tradition of Professor Aubrey Lewis. Michele would recall that Michael Shepherd was fond of quoting Daniel Tuke, who wrote in 1884 ‘scepticism in the physician is the best means of arriving at the truth: faith in the patient the best means of arriving at health.’ Despite this, he was less sceptical when he met Christa Zimmerman, a young German clinical psychologist also working at the IoP in London, whom he later married as they moved to work in Verona in 1970.

Throughout his career Michele completed a series of stunning achievements, during four phases of his work. First, a focus upon animal psychopharmacology (1966–1968), researching amphetamine metabolism in animals and the turnover of amines in the brains of aggressive mice. He moved next to clinical psychopharmacological investigations (1968–1983), including controlled clinical trials in anxious and depressed patients, as well as the residual effects of benzodiazepines and barbiturates in normal subjects and in anxious patients. He is best known, however, for his landmark studies in epidemiological, social and community psychiatry. His initial research in these fields (1969–1985) encompassed studies on the epidemiology of suicide and para-suicide, the validation of screening questionnaires, case register studies on incidence, prevalence and patterns of care, alongside projects on common mental disorders in general practice and in general hospitals. In the fourth phase of his work (1985–2015), he deepened his knowledge of these fields and also published widely on the evaluation of the effectiveness and cost-effectiveness of community mental health services, while collaborating with colleagues in Verona undertaking genetic and neuroimaging studies in schizophrenia and bipolar disorder.

He was interested in community-based services not only as an academic exercise. He led the creation of a comprehensive system of psychiatric services in Verona, which he determined should be committed both the highest standards of care, and be firmly grounded in evidence-based medicine. He had the foresight to realise that evaluating these services properly required exact enumerator and denominator data, so he created the South Verona Psychiatric Case Register. This provided detailed, longitudinal data on population levels of met and unmet need for care, and mapped trends in the transformation, after 1978, from a hospital-based system to what he called the ‘balance care model’, combining community and hospital provision.

Over this period he led a series of important studies on fundamental and applied psychiatric epidemiology. He created a research team to conduct superb mental health service research, and to create a series of psychometrically strong scales to assess progress. He was a founding member of the European Network for Mental Health Service Evaluation (ENEMSH). He directed the World Health Organisation (WHO) Centre for Research and Training in Mental Health and Service Evaluation in Verona. For over 30 years he was a member of the Member of the WHO Expert Advisory Panel on Mental Health. He lectured very widely and very well, in a total of 22 countries worldwide, and he was sometimes rather surprised to find that his papers and books were well known, for example, in China, Japan and South Korea. His talks were always marked by precise preparation, a strong sense of his innate humanity, and also sometimes by bright colour combinations!

His excellent clinical, scientific, administrative and policy judgement meant that he was in great demand from scholarly and professional bodies including the following roles: member of the Epidemiology and Public Health Committee of the World Psychiatric Association; Vice-President of the Committee of the International Federation of Psychiatric Epidemiology; member of the National Committee for Mental Health, Ministry of Health, Roma; member of the National Committee for Health Research, Ministry of Health, Roma; Honorary President of the Italian Society of Psychiatric Epidemiology; and as  Vice-President and later President of the Società Italiana di Epidemiologia Psichiatrica (SIEP). Moreover, as Associate Editor or Advisory Board Member he was engaged  for  many leading journals, such as  Social Psychiatry and Psychiatric Epidemiology, the British Journal of Psychiatry, Acta Psychiatrica Scandinavica, the International Review of Psychiatry, World Psychiatry, Psychological Medicine and the  International Journal of Methods in Psychiatric Research. In each role he was valued for his experience, wisdom, discretion and sense of balance.

These abilities, both creative and synthesising, were given full recognition on his election to the position of Dean of the Faculty of Medicine and Surgery at the University of Verona, in which capacity he served for two terms (2006–2012). He combined a fierce commitment to improving clinical and scientific quality, along with a clear sense of how to show strong leadership in a large organisation with complex external and internal relationships. During this time psychiatric and psychological research in Verona flourished, with the Department of Mental Health (which he lead) and the Clinical Psychology group (led by Christa Zimmerman) both rated as the best in Italy in a national assessment of research excellence.

These qualities also infused all his work for this journal. Michele established the journal as Epidemiologia e Psichiatria Sociale in 1992, dedicated ‘to give priority to highly relevant and innovative research articles and systematic reviews in the areas of public mental health and policy; mental health services, system research; and epidemiological and social psychiatry.’ Despite his many other roles, Michele's relentless focus upon scientific excellence and his painstaking eye for quality and detail meant that the reputation of the journal grew from strength to strength. He carefully arranged the transfer of the journal to Cambridge University Press in 2010, when it was retitled Epidemiology and Psychiatric Sciences. He would have been delighted to see that the most recent Impact Factor for EPS has risen to 3.907.

When interviewed in 2003 for the Psychiatric Bulletin he was asked ‘What are your interests outside of work?’ He answered ‘The arts and literature, but I feel I have too little time for them. I dream to be able to read in the future, after my retirement, in 10 years’ time, all the books I was unable to read and that I am still unable to read now.’ Despite this wish, in fact time was not kind to Michele towards the end of his life. Just before his planned retirement in 2013 he discovered that he had a form of cancer. Trusting to evidence-based medicine he underwent a series of treatments, but the disease was even stronger than his constitution and his will. After a long period of treatment, during which time he continued as Editor-in-Chief of EPS, he was admitted to hospital and just a few weeks later Michele left us.

Many of us knew Michele from his work: a leader in his pioneering commitment to developing policies and services that are soundly based on evidence of what works; a man uncompromising in seeking the scientific truth in his investigations; a choreographer highly skilled in building accomplished clinical and research teams; a scientific editor who created a flourishing journal successfully supporting the best work in the fields of epidemiology and psychiatric sciences; and a man who would write clear and topical articles on mental health for local and national newspapers. His productivity was prodigious: a total of 558 scientific papers, and 10 authored or co-authored books, while also editing a further 24 books and monographs.

He was particularly committed to supporting early career researchers, often arranging for placements abroad to enrich their experience and to enhance their ambitions, just as he had gained from his own time abroad. This blend of a focus on the needs of individual patients and colleagues, and a clear eye for the larger public health perspective made Michele a most unusually talented psychiatrist. Indeed he sometimes wrote of his work as acting in the spirit of both an archaeologist and architect of psychiatry.

Some of us also knew Michele personally, and valued his great generosity of spirit to his friends and his colleagues, his ability to inject welcome humour into almost any situation, his love of gardening and creating beauty in his home, and his innate intensity, restlessness and impatience to solve problems, whatever the time of day or night. He was both a confident and a modest man, somewhat embarrassed when hundreds of patients, colleagues and friends paid handsome tribute to him at his Festschrift retirement event in Verona in 2013. He did not live to enjoy the time for reading that he had anticipated, and for we who survive him, Michele died far too soon. Yet in the time that was available to him, he achieved so much. His legacy is that which will continue, through us, into the future.