Executive Director's Column
The Strategic Plan of NIMH
By Steven Breckler
The World Health Organization (WHO) defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
It is interesting to compare this perspective on health with that of the National Institute of Mental Health (NIMH), which bears primary responsibility in the United States for advancing research and knowledge about mental and social well-being. The masthead of the NIMH website proclaims its mission as “reducing the burden of mental illness and behavioral disorders through research on mind, brain, and behavior.”
The approach of NIMH departs from that of WHO in an important way. By emphasizing “illness” and “disorders,” NIMH has lost sight of what we are ultimately after: well-being.
Against this backdrop, and with much anticipation, NIMH recently circulated a draft of its new strategic plan. Finally, we hoped, NIMH would see the merit of critical commentary complaining that the Institute focuses too much on the brain and too little on behavior. Finally, we thought, a fresh opportunity for NIMH to bring itself into closer alignment with the international health community’s emphasis on mental well-being, and not merely mental illness.
At first glance, the NIMH draft strategic plan seems to emphasize the right things: promoting scientific discovery; charting mental health trajectories; developing new and better interventions; and strengthening public health impact.
Upon closer scrutiny, however, we find the objectives so nicely identified by NIMH as unlikely to be met by the specific strategies to be deployed. Indeed, the draft strategic plan stands as more a reaffirmation of where NIMH currently stands than a plan for achieving future goals.
For example, the first objective of NIMH is to “promote discovery in the brain and behavioral sciences.” Yet, nearly all of the particular strategies and bullets that are listed for accomplishing this objective concern research that falls within neuroscience and genetics. Very little attention is given to the contributions of the behavioral and social sciences.
The failure of NIMH to capitalize on recent progress and opportunities within the behavioral and social sciences is disappointing, as work in those areas is critical for understanding the nature and development of the cognitive, affective, motivational, and social processes that go awry within mental disorders.
Much of the draft plan indicates that NIMH will only support projects in behavioral and social science that also include measures of brain function or that directly address particular disorders. Not only does this strategy defy logic, it stands in contrast to the advice of NIMH’s own advisory council and with the legislative mandate for NIMH.
Regarding the logical problem: NIMH should indeed support a research portfolio that is focused on the intersection of brain, behavior, and mental health. It does not follow, however, that studies of normal behavior pursued entirely at the behavioral or social level of analysis should be excluded merely because they do not include measures of brain function. Yet, this is what NIMH appears to be suggesting.
Regarding the advice of NIMH’s advisory council: In its 2004 report, Setting Priorities for Basic Brain & Behavioral Science at NIMH, the advisory council clearly indicated that NIMH should continue to support studies of normal behavior that use behavioral measures alone. The draft strategic plan seems to have ignored or dismissed the council’s good advice.
Regarding the legislative mandate: The1992 legislation authorizing NIMH requires the Institute to support “the promotion of mental health, and the study of the psychological, social and legal factors that influence behavior” (42 U.S.C. § 285p). This mandate remains binding, even after passage of the National Institutes of Health Reform Act of 2006. The NIMH draft strategic plan is clearly moving away from the Institute’s own mission and from the legislative intent of the law.
The draft NIMH strategic plan is silent or merely pays lip service to numerous challenges that fall within its mission and that follow from the legislative mandate. The plan says little about aging populations, socio-cultural variables, changing demographics, trauma, or violence. Although the draft plan discusses many avenues for empirical research, it says little about the tremendous promise of theoretical and computational modeling research, especially at the systems neuroscience and behavioral levels.
I recognize that I use this space frequently to air concerns about the direction NIMH has taken. The institute does great things, but it is pursuing a narrow agenda. The drafting of a new strategic plan offered the hope of correcting this deficiency. Perhaps the second draft will be better.
Read APA’s formal comment on the NIMH draft strategic plan.