The National Institute of Mental Health (NIMH) wants to focus on
transforming the understanding and treatment of mental illnesses. An
announcement by NIMH Director Thomas Insel, M.D., on July 29 outlines four
overarching objectives that will set the priorities for the institute's
investment in the next five years.
One objective is to further uncover the biological causes and mechanisms of
mental disorders through research in genetics, neurobiology, behavioral
science, and other specialties.
Advances in these areas will integrate understanding of the brain and
observed behaviors as well as genetic and environmental factors in various
diseases. One of the research goals will be to reconsider the classification
of mental disorders based on dimensions of observable behaviors (for example,
cognitive impairment in schizophrenia and dementia, psychosis in bipolar
disorder and schizophrenia) with direct links to neurobiology. This may lead
the current clinical-symptom-based diagnostic criteria to be revised or
"The strategic plan is driven by the recognition that there are new
and outstanding scientific opportunities in mental health research,"
Insel told Psychiatric News. "We want to exploit these
opportunities and focus on what we believe are the most important
objectives—areas that hold the most promise to transform mental health
care, including new, effective treatments."
Another objective calls for getting a longitudinal view of the progression
of all mental illnesses and understanding their early development to create
prevention and early-intervention strategies. A growing body of evidence
suggests that abnormal neurodevelopment early in life may be the key to the
pathogenesis of many mental illnesses, even though behavioral symptoms may
emerge years or decades later. By charting the complete trajectory of these
disorders and describing specific risk factors or triggers, the institute
hopes to be able to discover interventions to treat the disorders in early
stages or prevent them altogether.
Psychiatric research and practice have traditionally focused on late-stage
symptoms of these disorders, that is, behavioral manifestations, Insel pointed
out. "We have to get serious about detecting these illnesses in their
early stages. For this we need to find reliable biomarkers for predicting the
risks or detecting early stages of mental illnesses, like cholesterol levels
for heart disease or [prostate-specific antigen] for prostate
In addition, NIMH will give priority to research into devising personalized
interventions for people with mental illness. Genetic as well as environmental
variations, including cultural and family factors, are responsible for partial
and unpredictable responses to current therapies. Some may go through many
trial-and-error courses of therapy without benefits. For example, NIMH-funded
studies have already revealed several genetic variations to account for
response to antidepressants in some people and serious adverse effects in
others. If clinicians can predict who will respond to what treatment with the
least safety risk early on, most patients can get better faster without
enduring serious side effects. Achieving this objective requires more
personalized studies that do not lump all subjects together.
The fourth objective is to better translate research into public health
outcomes, a challenging goal since adopting discoveries is usually slow. To
this end, NIMH plans to strengthen its partnership with health care payers,
service providers, patients, advocacy groups, professional organizations, and
other federal agencies involved in mental health issues, such as the Centers
for Medicare and Medicaid Services and Department of Veterans Affairs.
"The central theme of this plan is to shift the way we think about
mental illnesses so that we begin to address these as brain diseases, really
disorders of brain circuits. That is the transformative message of the
strategic plan," said Insel. "The concept is demonstrated in
Parkinson's disease, whose symptoms do not emerge until 80 percent of the
cells [in the diseased brain region] are gone. Mental illnesses could be
viewed in a similar way, with behavioral symptoms representing a late stage of
the disease process.
"The hope is that, if we are able to deliver on the objectives, we
will move closer to predictive, preemptive, personalized, and participatory
medicine. It's a priority to seek biomarkers to help detect the risks,
implement early interventions, and personalize care that involves the patient
and family. We do that now in cancer and heart disease, but not in mental
An exciting indication of the changes to come is that the word"
cure" was mentioned in the strategic plan. Although it is too
early to expect the discovery of a cure for any major mental illness in the
next five years, Insel noted, "I think it is important that people in
mental health hold themselves to the same ultimate goal as all other areas of
medicine—to find a cure." The plan "raises the bar of
expectation in the mental health care community."
The strategic plan was developed over a one-year period and incorporated
input from NIMH staff, outside organizations, and more than 500 individuals in