Serious mental illness is a neglected research topic among all but a few psychological scientists. If you were surprised to see this title on the column of APA's Executive Director for Science, please read on. My aim is to suggest that a broader spectrum of psychological scientists must tackle the research challenges presented by those diagnosed with serious mental illnesses and by their families.
In his preface to the volume, Mental Health: A Report of the Surgeon General that was published in December, Dr. David Satcher clearly summarized the current state of affairs. He wrote, "This report makes evident that the neuroscience of mental health--a term that encompasses studies extending from molecular events to psychological, behavioral, and societal phenomena--has emerged as one of the most exciting arenas of scientific activity and human inquiry." Research on serious mental illness is vital to the health of our nation as we move into the 21st century. Serious mental illness exerts a crippling effect on the health status of many Americans and is in many ways a well-kept secret. For example, data from the Global Burden of Disease study indicate that mental illness, including suicide, was second only to cardiovascular disease in its impact on disability in the developed nations of the world in 1990. If we look ahead to 2020, the impact of mental illnesses on disability throughout the world will be even greater.
Another challenge in addressing the impact of serious mental illness on our nation is the stigma that is associated with a diagnosis of severe mental illness. This stigma is played out in the deplorable ways in which our society treats persons diagnosed with mental illnesses and, all too often, their close family members. How then can psychological science address this major national need?
Behavioral science into action
The National Institute of Mental Health (NIMH) is the key federal agency for advancing the basic and clinical sciences to improve our understanding of mental health and mental illness. My Science Directorate colleagues and I are excited about the possibilities for advancing a balanced research agenda at NIMH that promotes the application of basic behavioral research findings to address the challenges of serious mental illness. This agenda is described in a recent report, "Translating Behavioral Science Into Action," prepared for the National Advisory Mental Health Council (NAMHC) by its Behavioral Science Workgroup. This report provides a clear and compelling blueprint for fostering greater involvement of basic behavioral scientists in clinical research questions. The report may be found at http://www.nimh.nih.gov/tbsia/tbsiatoc.cfm. Soon after completion of the report, NIMH issued a program announcement on "Integrating the Basic Behavioral Sciences and Public Mental Health" (PA-00-078).
Three primary issues ripe for translational research included in the report are:
How are basic behavioral processes altered in mental illnesses and how are these processes critical for improving diagnosis, treatment, rehabilitation and prevention?
What impact do mental illnesses and various treatments have on the ability of people to function within their families and in school or the workplace?
What is the impact of social, cultural and other environmental contexts on the etiology, treatment and prevention of mental illnesses?
My strong belief is that the fuel that will power new insights and advances in the etiology, treatment and prevention of serious mental illnesses will be generated from basic research by behavioral and brain scientists. Unfortunately, our society has been reticent until recently to make these investments in basic research as the return on investment is not immediate. Now, NIMH faces the challenge of accelerating the translation of basic research findings into practice. The NAMHC report provides many valuable insights and still others will develop over time.
Hope for the future
One thing is clear. Consumers and family members must work closely and cooperatively with researchers and NIMH officials to capitalize fully on the opportunities that are now available. Researchers have much to learn by reaching out to consumers and family members for their unique perspectives on these devastating illnesses. The greatest hope for the future involves an active partnership between funders, scientists, consumers and family members such that research projects are firmly grounded in the real life experiences of those whose lives have been so profoundly affected by these diagnoses and the health-care system's treatment responses to them. My hope is that the release of this report will prove to be a watershed event in addressing the needs of primary consumers and their families.
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