NIMH Plans Accelerating Research to Remedies

A strategic plan to guide research priorities and resource allocations of the NIMH was released recently by NIMH Director, Thomas R. Insel, MD.¹ The plan is intended to provide direction over the next 5 years toward the institute’s stated vision of “a world in which mental illnesses are prevented and cured.”

Insel credited the plan to a year-long collaboration of the institute staff with outside scientists, advocacy groups, and more than 500 members of the public. In a message accompanying the document, Insel referred to the present period as a “Decade of Discovery” that has followed breakthrough insights into brain mechanisms and developments in functional brain imaging in the 1990s-a “Decade of the Brain.” Although the current era is marked by accelerating discovery, Insel also characterized it as being marred by large populations affected by or at risk for mental illness who remain without adequate treatment.

“America is a different nation than it was 10 years ago,” Insel observed. “We are more diverse, we are aging, and we are increasingly challenged by the costs and complexities of health care.”

In this environment, Insel indicated, it is not sufficient for the NIMH to gauge its accomplishments only by the traditional measures of the numbers of grants, papers, or even discoveries from the funded research. “In addition, NIMH must measure success by ‘outcomes’: how well the research we support provides the evidence base for mental health care providers to preempt illness for those at risk . . . enhance recovery for those affected, serve diverse and previously underserved populations, and reduce premature mortality among persons with mental illness.”

With this shift in emphasis, support of research on the causes of mental disorder is only the first of 4 strategic objectives in the 5-year plan.

• The second objective is to chart the course of mental disorders over the life span to determine the optimal time and means by which to intervene.

• The third is to develop better interventions “that incorporate the diverse needs and circumstances of people with mental illness.”

• The fourth is to strengthen the public health impact of the supported research “to help close the gap between the development of new, research-based interventions and their widespread use by those most in need.”

Objectives for closing the gap

In calling for and planning research projects on the course of mental illnesses, the institute intends particular focus on early stages of disorders. “Doing so will allow us to pinpoint the best times and techniques to preempt the onset of symptoms or halt or reverse the progression of illness,” the strategic plan states.

The institute plans to increase the cultural diversity of the studied populations and, if necessary, extend studies to include international populations and isolated cases. Noting the success of cardiology in researching risk factors for coronary artery disease across broad populations, the institute indicated its intent to identify “malleable and robust” risk factors for different phases in the trajectory of mental illnesses.

In setting its third objective, the institute will promote new psychosocial and biomedical intervention trials that focus on the moderators and predictors of intervention response. These will not just be exploratory trials, according to the strategic plan, but will include prospective trials to determine whether use of the identified predictors actually enhances recovery.

In addition to new population studies, the institute plans to access data from administrative records and epidemiological studies and provide analysis that may either support promising clinical strategies or dissuade use of practices with little merit. Recognizing that wide application of tested interventions is often a function of cost-benefit analysis, the institute also plans research on these considerations and on strategies to minimize adverse treatment effects.

The institute plan considers the possibility that early mental health interventions may not be applied by traditional mental health care providers and foresees greater involvement with primary care and pediatric physicians as well as school personnel. “In order for intervention research to succeed,” the plan states, “it must incorporate the perspectives of these various providers and take into account the diverse systems in which interventions are delivered.”

The final strategic objective to close the gap between discovery and application will involve supporting research on the current barriers to this progression. The plan calls for eliciting input from stakeholders and nurturing partnerships among NIMH and other NIH institutes and agencies developing services research. Examples of opportunities to build on cross-NIH initiatives noted in the strategic plan include the NIMH Roadmap for Medical Research and the NIH Blueprint for Neuroscience Research.

Insel referred to an “unavoidable tension” between the urgent need for services transformation and the long-term nature of scientific progress but indicated his optimism that the NIMH will contribute to gains in both. “This plan is our commitment to continue the accelerated pace of scientific progress by generating, over the next 5 years, the best mental health research that will have the greatest public health impact and continue to fuel the transformation of mental health care.”

References:

Reference

1. National Institute of Mental Health Strategic Plan. http://www.nimh.nih.gov/about/strategic-planning-reports/index.shtml. Accessed September 17, 2008.