Meeting Summary (Outreach)
Alliance for Research Progress — February 18, 2011 Meeting
February 18, 2011
The National Institute of Mental Health (NIMH) convened its fourteenth meeting of the NIMH Alliance for Research Progress (Alliance) on Friday, February 18 in Bethesda, Maryland; this document provides an overview of the proceedings. The Alliance meeting serves as an opportunity for participants to hear about exciting new research and advances in the field, to network with colleagues, and to interact directly with the NIMH Director, Thomas Insel, M.D., and senior NIMH staff. Invitees included representatives from national voluntary organizations representing individuals and families affected by mental illness. Participants heard presentations on future directions for the National Institutes of Health (NIH), new initiatives for the mental health and neuroscience advocacy community, opportunities and challenges for mental health in the era of health care reform, the National Advisory Mental Health Council (NAMHC) report on interventions, From Discovery to Cure: Accelerating the Development of New and Personalized Interventions for Mental Illnesses, and a new NIMH study, Establishing Moderators/Mediators for a Biosignature of Antidepressant Response in Clinical Care (EMBARC). Guest speakers included The Honorable Patrick Kennedy (D-RI), former Member of the U.S. House of Representatives; Susan Dentzer, M.A., Editor-in-Chief, Health Affairs; David A. Lewis., M.D., Director, Translational Neuroscience Program, University of Pittsburgh and Member of the NAMHC; and, Myrna M. Weissman, Ph.D., Professor, Epidemiology and Psychiatry, Columbia University and Chief, Division of Epidemiology, New York State Psychiatric Institute.
State of the NIMH
Dr. Insel welcomed participants and opened the meeting with his State of the NIMH address, in which he discussed current events affecting the mental health community, recent research advancements and developments at NIH, and the outlook for the overall NIH budget. He told Alliance members about The National Action Alliance for Suicide Prevention (Action Alliance), which was launched in September 2010 by Kathleen Sebelius, Secretary of Health and Human Services, and Robert Gates, Secretary of Defense. The Action Alliance, under the direction of the Substance Abuse and Mental Health Administration, is charged with developing a national agenda to decrease and prevent suicides. Dr, Insel mentioned the recent shootings in Tucson, Arizona and stated that the topic of mental illness and violence is a complex one – the mental health community needs to find the right balance to protect the public and the rights of individuals with mental illnesses. He updated the group on recent developments at NIH including the recommendations by the Scientific Management Review Board, which resulted in the pending merger of the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, and the creation of the National Center for the Advancing Translational Sciences (NCATS). The NCATS will include aspects of the National Center for Research Resources, the Clinical and Translational Science Awards program, the Cures Acceleration Network, and the Molecular Libraries project. In closing, Dr. Insel discussed the implications of the current appropriations debate on NIH and NIMH. He noted that the U.S. government is currently operating under a continuing resolution set to expire on March 4, 2011 and that it is unclear if the final budget will be at fiscal year (FY) 2010 or FY 2008 levels. Increases in funding seem unlikely, and if the appropriation is rolled back to FY 2010 levels, NIMH may be able to support grants only at the eighth percentile; even fewer grants could be funded at FY 2008 levels.
From Discovery to Cure: Report of the National Advisory Mental Health Council
David A. Lewis, M.D., Director of the Translational Neuroscience Program at the University of Pittsburgh and member of the NAMHC provided an overview of the NAMHC report From Discovery to Cure: Accelerating the Development of New and Personalized Interventions for Mental Illnesses. Using schizophrenia as an example, Dr. Lewis discussed the limited effectiveness of antipsychotic treatments, the lag-time in discovery of psychotropic medications relative to drugs for cardiovascular disease, and how many of the current treatments were discovered by serendipity or were designed to mimic the same mechanisms of action as earlier medications. He detailed the charge of the NAMHC Interventions Workgroup: to stimulate the science for developing the next generation of interventions for mental disorders, especially those that are pre-emptive and personalized. He also outlined four goals for intervention development identified by the Workgroup:
- Discover and develop novel, effective interventions that prevent and cure mental illnesses;
- Optimize current treatments and NIMH’s treatment research;
- Use existing resources effectively; and,
- Create partnerships.
Dr. Lewis told Alliance members that the challenges to developing new interventions for mental illnesses are great, but so are the scientific opportunities and potential public health impact. In addition, new tools and approaches currently being developed will provide NIMH with a historic opportunity to dramatically change the lives of individuals with mental illnesses.
Overview of the Establishing Moderators/Mediators for a Biosignature of Antidepressant Response in Clinical Care (EMBARC) Study
Myrna M. Weissman, Ph.D., Professor of Epidemiology and Psychiatry at Columbia University; and Chief of the Division of Epidemiology at the New York State Psychiatric Institute shared information on the NIMH EMBARC Study, a first step in discovering biosignatures for the personalized treatment of depression. Dr. Weissman discussed how the study joined two NIMH grantees to develop a cooperative protocol focusing on biomarkers and depression. She told Alliance members that while effective interventions are available for the treatment of depression, there is considerable variation in individual treatment outcomes. EMBARC researchers hope to identify a standard set of biomarkers and other measures that can be used to predict which interventions will produce the best treatment outcomes for an individual. The study will systematically collect data on clinical moderators, electrophysiology moderators, behavioral phenotyping moderators, neuroimaging moderators, and blood samples. The data will be de-identified and preserved in a repository for use by other scientists and for future study and analysis. Dr. Weissman also discussed the research design, schedule of assessments, and milestones completed since the initiation of the study in September 2010. Co-investigators on this study include Madhukar H. Trivedi, M.D., University of Texas Southwestern; Maurizio Fava, M.D., Massachusetts General Hospital; and Patrick J. McGrath, M.D. and Ramin V. Parsey, M.D., Ph.D., Columbia University.
Mental Health Issues in Health Reform: Opportunities and Challenges
Susan Dentzer, M.A., Editor-in-Chief of Health Affairs, shared her views about the opportunities and challenges facing the mental health community during this time of healthcare reform. She told Alliance members that opportunities abound throughout the Patient Protection and Affordable Care Act of 2010 (PPACA) to help modernize addiction treatment and mental health services, although challenges exist regarding the law’s implementation, definitions, appropriations, and survival. She discussed the structure of the PPACA and major changes to the current health care system, including expanding coverage to approximately 32 million Americans from 2014 to 2019. Many of these individuals are uninsured and have mental health conditions may now be able to receive care under PPACA and the Mental Health Parity and Addiction Treatment Act. Ms. Dentzer informed Alliance members that Secretary Sebelius will appoint a commission to create an essential health benefits package, as outlined in the law. According to the law, the package is to provide a comprehensive set of services including mental health and substance use services, behavioral health treatments, prescription drug services, and rehabilitative services. However, many issues about exactly what will be included the package remain to be decided. She encouraged Alliance members to be alert for any news concerning the commission or package, and to be attentive to opportunities to contribute to its formation. Ms. Dentzer also discussed delivery system innovations and reforms including the “triple aim” approach of the Centers of Medicare and Medicaid Services, as well as the benefits of organizations that deliver high-quality health care while at the same time managing resources efficiently.
The Next Frontier: One Mind for Brain Research
Former Rhode Island Congressman Patrick Kennedy, who was instrumental in the passage of the Mental Health Parity and Addiction Treatment Act, introduced The Next Frontier: One Mind for Brain Research (www.moonshot.org) initiative to the Alliance. He talked about the politics of neuroscience and the importance of working cooperatively to make brain research a national security issue. He discussed stigma associated with mental illnesses and importance of rallying behind veterans and individuals currently serving in the armed services to make sure that they are receiving the necessary care to address the ‘invisible’ wounds of battle. He underscored the importance of veterans’ mental health needs as an issue shared by all Alliance members. Moreover, he encouraged Alliance members to join The Next Frontier to present a unified position on mental health and increase public awareness and education through branded messages, just as the country rallied behind President Kennedy to put a man on the moon.
During the question and answer period, Alliance members inquired about next steps and how to join the effort. Mr. Kennedy noted that there would be a process set in place to establish a governance structure and determine target areas where the group would be most effective. Philip Wang, M.D., Dr.P.H., Deputy Director of NIMH, provided an update on the ongoing Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS), and Dr. Insel talked about how The Next Frontier might partner with NIH to ensure neuroscience research is included in the initiative.
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