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Research at NIMH: Looking Ahead
By Thomas Insel
Editor's comment: PSA invited Tom Insel, Director the National Insitute of Mental Health, to address concerns in the psychological science community about changes in the NIMH mission and funding portfolio. He describes his vision of NIMH's mandate and purview.
With forecasts of either minimal increases or actual decreases in NIH budgets, it's not surprising that many scientists are anxious about the future of NIH support for their research. Behavioral scientists, in particular, have expressed concern that basic behavioral science, traditionally supported by the National Institute of Mental Health (NIMH), may be specifically targeted for reduced funding or even elimination by the NIMH. This is not the case. However, we are setting priorities for funding - an essential response to the new budget reality. I appreciate this opportunity to explain how we plan to do this.
The NIMH mission is to reduce the burden of mental and behavioral disorders through research on mind, brain, and behavior. Like other disease-specific institutes at NIH (such as the National Cancer Institute or the National Institute of Allergy and Infectious Diseases), our goal is to generate research that will enhance prevention of and recovery from specific illnesses. And like these other institutes, we view basic science - in our case, research on brain and behavior - as the engine of scientific discovery necessary for success. We also recognize that discovery is not enough; we need to ensure that discoveries translate to the clinic and ultimately into widespread practice. This translation of science to service is a necessity for our nation and an urgent priority for us. As stewards of federal funds, we are accountable to the American public to generate high-quality research that will ultimately relieve the suffering associated with mental disorders.
For NIMH to meet these ambitious goals in the current budget climate, we need to set priorities. In doing so, we have followed three principles. First, we solicited input from our many stakeholders: patients, families and their advocates, grantees and their professional societies, Congress, and the National Advisory Mental Health Council (NAMHC), which includes public members. Second, we have asked workgroups of the NAMHC to review NIMH portfolios in basic science and clinical trials and to recommend priority areas for future investment. The basic science report can be found on the NIMH website. And finally, we have been reviewing both current and new grants with respect to three factors: relevance, traction, and innovation. In this context, relevance means connection to the Institute's mission, traction indicates capacity for rapid progress, and innovation refers to novel areas or approaches that are under-represented in the portfolio. The result of these discussions will be a list of priorities posted on the NIMH web site by each extramural program to guide grantees to areas of investment. High priority will go to studies of the pathophysiology of mental disorders and studies that may lead to new interventions aimed at reducing the burden. This will require not only applying the best behavioral, genomic, and neuroscience insights, but also developing new insights and approaches in each of these disciplines. We want to be entirely clear on this point. Much of the basic science we fund may not be immediately ready for translation; yet it will address basic questions about behavior, brain, and experience that are informed by and, in turn inform, the understanding of mental disorder, recovery, or resilience.
Indeed, without a strong basic science research program, we will not have the science to translate in the next decade. Certain areas traditionally supported by NIMH may be considered lower priority because they are a high priority for other institutes or for the National Science Foundation. For instance, grants on visual sensory processing belong to the National Eye Institute, studies of communication are at the core of the National Institute of Deafness and Communication Disorders, and much of the research characterizing normal development, parenting, marriage, and family is central to the National Institute of Child Health and Human Development; as a result, such studies will be a lower priority for NIMH. There will be exceptions to these guidelines based on the focus of individual proposals, but as a general rule, NIMH will endeavor to focus its portfolio around specific priorities, with attention to relevance, traction, and innovation.
There is no doubt that within the realm of basic science, basic behavioral research will be vital to our success. Mental disorders are the result of genetic vulnerability and experience. Increasingly, we are learning how these interact; we now know, for example, that specific genetic alleles confer risk for depression following stressful life events (Caspi et al, Science, 2003) and that varying developmental experience can modify genomic structure via methylation in select brain regions, with long-term consequences on behavior (Weaver et al, Nature Neurosci, 2004). Exploring how brain, behavior, and experience interact, we believe, will lead to the discoveries fundamental for understanding and successfully intervening in mental disorders. In addition, behavioral, social, and cognitive science research will be essential for valid diagnostic tests, clear phenotypes, new treatments, prevention efforts, and ultimately, dissemination to diverse populations.
How do we further exploit the gains we have made to meet the challenges ahead? How can we encourage more behavioral science that informs the development of new interventions or helps elucidate the intricacies of brain-behavior interactions? We believe that cross-disciplinary interaction and collaboration is a key means of accomplishing these translational goals. We have seen recent progress in the interdisciplinary study of the extinction of fear memories, which has provided new neurobiological insights and novel interventions for PTSD. There has also been significant advancement in the examination of the long-term consequences of stress during early development, which has provided new approaches to the pathophysiology of depression. Social neuroscience is another exciting new interdisciplinary research area, where the new tools of neuroscience - from transgenic mice to neuroimaging in humans - have yielded insights about social cognition, important for understanding the pathophysiology of autism.
As we are urging increased communication and interaction among our research communities, our organizational structure is being re-focused to facilitate and accelerate translational and interdisciplinary science. The aim of the new structure is to enable the rich promise of discovery offered by basic research to more clearly identify brain-behavior pathophysiology - and to translate this critical knowledge into developing more effective interventions that target symptoms and functioning. As a part of the reorganization we will recruit several new program officers in areas relevant to translation, including basic behavioral science.
Fully integrating across levels of analysis will require changing our scientific culture. One means of accomplishing this will be through the support of research training that emphasizes cross-disciplinary interaction and translation. For many years, NIMH has been among the lead NIH Institutes in support of research training and career development, with nearly 10 percent of its budget devoted to these programs. This represents twice the investment made by many other Institutes. However, we must seriously consider whether to continue to support and encourage such a large pipeline of researchers if funding opportunities become even more competitive. We will continue to support training and career development grants, but we must sharpen our focus, identifying the key areas and skills that will prepare new investigators to be highly competitive by pursuing innovative research that is highly relevant to our public health mission and priorities.
Priority-setting and reorganizing are always complex, difficult tasks. But we must remember that they are driven by the need to get new and existing therapies to the millions who are desperately in need of them, and to prevent these diseases whenever possible. Integrating the insights from behavioral and cognitive research with new approaches in genomics and neuroscience will build on the progress achieved thus far in understanding and treating mental illness. Our goal is to capitalize on this impressive nexus of scientific fields and combine them to redefine the boundaries of behavioral and biomedical neuroscience research. We clearly need the behavioral sciences community to address the complexity of mental disorders in terms of etiology, diagnosis, prevention, treatment, and access to care. I ask you and members of this community to help NIMH address these challenging scientific and public health issues.
For more information, contact Kate Egan at the Office of Science Policy and Program Planning (301-443-5766).