Insel to Step Down as Director of NIMH

After serving 13 years as director of the National Institute of Mental Health (NIMH), Thomas Insel, M.D., will step down effective November 1. Insel first worked at NIMH from 1980 to 1994 in the Division of Intramural Research and then returned as director in 2002.

David Hathcox

He will be leaving NIMH to join the Google Life Sciences (GLS) team at Alphabet (formerly Google) to lead a new effort that will focus on mental health. During the search for a new director, Bruce Cuthbert, Ph.D., will serve as interim director.

Insel has overseen NIMH during a period of remarkable advances in the understanding of the brain and the genetic and neurobiological underpinnings of mental illness, as well as in clinical research to improve treatment of mental illness. His leadership has helped to advance an appreciation of mental disorders as complex illnesses involving genes, interrelated neurocircuitry, the environment, and behavior. He has also been instrumental in the movement toward early identification of mental illness, recognizing that many of the most serious disorders begin well before they come to clinical attention.

APA leaders hailed Insel, saying the period of his leadership at NIMH has been transformative. “Dr. Insel provided excellent leadership of NIMH during this critical time in mental health research,” said APA President Renée Binder, M.D. “During his tenure, NIMH has spearheaded the BRAIN initiative [Brain Research Through Advancing Innovative Neurotechnologies] and other major research efforts. We look forward to assisting the Obama administration as it works to identify the next director.”

APA CEO and Medical Director Saul Levin, M.D., M.P.A., congratulated Insel on his service to NIMH and the larger field of psychiatry and mental health. “His new opportunity at Alphabet will increase mental health field advances well into the future, and we at APA look forward to continuing to work with him,” Levin said.

In a statement posted on the website of the National Institutes of Health (NIH), NIH Director Francis Collins, M.D., Ph.D., said that under Insel’s leadership, NIMH has “nurtured a culture of science that puts the needs of patients with serious mental illness at the center of its efforts.”

Integrating Neuroscience and Psychiatry

In addition to the BRAIN initiative, other major endeavors undertaken during Insel’s tenure include the Psychiatric Genomics Consortium, which involves more than 500 researchers in more than 80 institutions across 25 countries; the Army STARRS (Study to Assess Risk and Resilience in Servicemembers) project, a partnership with the Department of Justice on the largest study of mental health risk and resilience of military personnel; the National Database for Autism Research, considered the most significant repository for autism-related data; and RAISE (Recovery After an Initial Schizophrenia Episode), an NIMH research effort that seeks to change the trajectory and prognosis of schizophrenia through coordinated and aggressive early treatment. 

“When I came to the directorship in 2002, I had a number of things I hoped to accomplish, and one was to integrate neuroscience and psychiatry and create a new discipline of clinical neuroscience,” Insel told Psychiatric News. “I think that has happened, and over the last decade we have seen a new cohort of brilliant young neuroscientists who are now focused on trying to understand serious mental illness. While I think that effort isn’t complete, it is well on its way to success.”

He added that a metric for the success of this integration of neuroscience and psychiatry is the increase in the number of M.D.-Ph.D. researchers who are interested in training in psychiatry.

Insel said that while APA and NIMH have distinct missions, their goals and objectives complement each other. “A really critical issue that has emerged in the last decade has been the gap between research and practice in psychiatry—the fact that it takes many years to translate research into changes in practice,” he said. “A part of the reason for this gap has been the way we do research—which has largely been within academic settings that are often far removed from the real world of clinical practice.

“What we’ve learned from areas of medicine that have made progress in closing this gap—such as pediatric oncology and pediatric cardiology—is the importance of moving research into practice. What I would love to see develop is what is sometimes called ‘the learning health care system’ in which practice becomes a way of optimizing diagnostics and therapeutics.”

He said APA’s Practice Research Network—composed of clinicians who collect and share clinical research data from their practices—is an important step in the right direction. “The Practice Research Network is the kind of initiative that benefits APA, NIMH, and ultimately patients and clinicians,” he said.

Insel said he saw no conflict between DSM and the Researcher Domain Criteria (RDoC), which was initiated at NIMH under his leadership to reconceptualize diagnosis of mental illness according to “domains” of brain function defined by genetics and neurobiology.

“RDoC is a guide to rethinking the way we do diagnosis and may inform DSM-6 or -7, but for now clinicians should be using the DSM and ICD,” Insel said. “At this point there is very little in genetics or neuroscience that can give us something better. RDoC is a pathway to get there, but is not a product that can be used in the near term.”

In May 2013, Insel and then APA President-elect Jeffrey Lieberman, M.D., issued a joint statement saying that along with the International Classification of Diseases, DSM “represents the best information currently available for clinical diagnosis of mental disorders” and that the two publications “remain the contemporary consensus standard to how mental disorders are diagnosed and treated.”

They added, “All medical disciplines advance through research progress in characterizing diseases and disorders. DSM-5 and RDoC represent complementary, not competing, frameworks for this goal.”

Insel said his new endeavor as a member of the Google Life Sciences team is an adventure that still waits to be defined. A wholly owned subsidiary of Alphabet, the Google Life Sciences team seeks to change outcomes in various areas of life science by at least tenfold—and Insel will be joining the team to identify those areas in mental health that are “ready for a times-10 change in outcomes.”

He added, “What those areas will be will depend largely on discussions we have over the next several months.” Insel will be relocating to the San Francisco Bay Area in January, when he joins the team.

After a great many accomplishments at NIMH, it is a “propitious” time to leave, he said. “The institute will be in very good hands with Bruce Cuthbert, while the search for a successor goes on,” Insel told Psychiatric News. “I believe the institute is in a very good place and poised to seize on new opportunities for the future.” ■