Winter meeting of the NIMH advisory council

Insel ponders ways to support the best science.

On Jan. 23, 2014, the National Institute of Mental Health (NIMH) held the winter meeting of its National Advisory Mental Health Council (NAMHC). With the government shutdown and sequester behind them, NIMH director Thomas Insel led off with his director’s report on the state of NIMH funded research, including NIMH involvement directly or indirectly in funding four of the 10 Science magazine breakthroughs of the year. Insel also spoke about the first round of funding opportunities for the BRAIN Initiative; NIMH is responsible for three of these six opportunities. Announced in December 2013, these opportunities have a March 2014 receipt date.  

Following up on the recent visit by Bill Gates to the NIH campus, Insel spoke of the 2013 report on the Global Burden of Disease study and the impact of mental health and substance abuse disorders. This research looked at the burden of 291 diseases, injuries and risk factors across 187 countries, including disability-adjusted life years (DALYs, the years lost to premature death or disability) of these various conditions. Gates described the philosophy of trying to invest “Dollars for DALYs” or investing in ways that will have the biggest impact (i.e., highest reduction in disease) by dollar spent. In the United States, DALYs for major depression, anxiety disorders, self-harm, drug use, alcohol use and schizophrenia have all either stayed level or increased in the past 20 years. Insel spoke of the need for NIMH to support the best science in light of the ongoing collective burden of behavioral health issues.

In the name of supporting the best science, Insel promoted NIH’s two tiers of peer review: scientific review groups which judge an application’s scientific merit and, at NIMH, the NAMHC which considers the application in the context of NIMH’s current projects and priorities. Insel also expressed the need for balance between investigator initiated unsolicited projects, focused on innovation and discovery, and solicited projects funded through requests for applications (RFAs) which target more specific needs and objectives of NIMH. He added that the state of the science in any particular area will determine the necessary balance between the two.   

In terms of who to support, Insel described how at NIH the mean age of a researcher awarded his or her first R01 grant is 42 years old. Thus, Insel raised the questions of how NIH could be supporting researchers earlier, during what is arguably their most creative years. Furthermore, he added that a small group of researchers appear to make a disproportionate number of scientific breakthroughs. Taking these factors into account, he raised the question of whether or not it made sense to provide more or longer support to these individuals. To address issues such as this, Insel highlighted the BRAINS program (not the BRAIN Initiative) aimed at soliciting highly innovative research proposals from early stage investigators.

In addition to Insel’s Director’s Report, the council meeting included a report on NIMH’s strategic planning efforts, aimed at updating the institute’s existing five year old plan. During the discussion of the new plan’s objectives, psychologist Marsha Linehan, attending her first meeting as a new Ad Hoc Consultant to the NAMCH, made the point that it was important to focus on behavior and behavioral therapies, in addition to biological approaches, as one of the fastest, most effective routes not only to treat mental disorders but also to change the brain. 

Grayson Norquist, who serves on the Board of Directors of the Patient-Centered Outcomes Research Institute (PCORI), presented on possible funding opportunities in mental health through participation on comparative clinical effectiveness research. More information on PCORI, it priorities, and funding opportunities can be found on its website.  

In order to further the development of new and better treatments, Jill Heemskerk, the deputy director of NIMH’s Division of Adult Translational Research and Treatment Development, presented on a shift in NIMH’s clinical trials portfolio in the direction of experimental therapeutics trials. By engaging in these proof-of-concept studies, researchers may be able to more quickly identify and confirm new targets for treatment, as is already the case for identifying new mechanisms and drug therapies for conditions such as heart disease and cancer.  

For more information please contact Craig Fisher.