Meeting Summary (Outreach)
Professional Coalition for Research Progress: 2011 Meeting
April 13, 2011
National Institute of Mental Health (NIMH)
The National Institute of Mental Health (NIMH) convened the seventh annual Professional Coalition for Research Progress Meeting (Coalition) on Wednesday, April 13, 2011 in Washington, D.C. The meeting served as an opportunity for representatives from professional organizations with an interest in NIMH research to hear about advances in mental health research and current and new research directions and strategies for NIMH; to network with colleagues; and, to interact with and express their views directly to the NIMH Director, Thomas Insel, M.D. and senior level staff. Invited speakers included Gregory E. Simon, M.D.; Pamela Collins, M.D., M.P.H., and Raquel E. Gur, M.D., Ph.D. This document provides a summary of the meeting highlights. See the meeting agenda and participant roster for additional information.
State of the NIMH
Dr. Insel welcomed Coalition members and provided a State of the NIMH address highlighting progress and priorities at the National Institutes of Health (NIH) and NIMH. He briefly discussed recent developments at NIH, including the recommendations by the Scientific Management Review Board regarding 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), scheduled to open in fiscal year (FY) 2012. He noted that NCATS will include aspects of the National Center for Research Resources, the Clinical and Translational Science Awards program, the Cures Acceleration Network, the Rapid Access to Interventional Development (RAID) program; the Therapeutics for Rare or Neglected Diseases (TRND) program; and the Molecular Libraries project. He discussed how these components would work together to accelerate the translation of discoveries into treatment.
Dr. Insel discussed progress on NIMH priorities including ongoing projects, recent research findings and discoveries, and the budget. He detailed the Institute’s commitment to and involvement in projects addressing suicide prevention including involvement on the National Action Alliance for Suicide prevention, an effort lead by the Substance Abuse and Mental Health Services Administration (SAMHSA) to significantly reduce the rates of suicide in the next 5 years and update the National Strategy for Suicide Prevention. In addition to these efforts to combat suicide, Dr. Insel also highlighted the U.S. Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS), which will function as a “Framingham-style” study to collect prospective and retrospective data from service members on suicide risk and resilience. He discussed the Recovery after an Initial Schizophrenic Episode (RAISE) study, a large-scale project that seeks to change the way schizophrenia is treated by developing and testing innovative and coordinated intervention approaches in the early stages of the illness when symptoms may be most responsive to treatment. He also spoke about the Establishing Moderators/Mediators for a Biosignature of Antidepressant Response in Clinical Care (EMBARC) study, a first step in discovering biosignatures for the personalized treatment of depression, as well as work on the Human Brain Atlas, which will help scientists better understand the different types of brain cells, the connections within the brain, and brain development. In closing, Dr. Insel reminded Coalition members about the Next Frontier collaborative effort, lead by former Rhode Island Congressman Patrick Kennedy, and discussed the implications of the current appropriations debate on the NIH and NIMH budget. He told Coalition members that the Institute anticipates a decrease in the number grants funded as a result of the decreased funding levels indicated by the FY 2011 continuing resolution.
Becoming a Learning Mental Health Care System: Transforming Practice into Research
Gregory Simon M.D., M.P.H., Senior Investigator at the Group Health Research Institute and a psychiatrist at Group Health’s Behavioral Health Service, presented information on the Mental Health Research Network (MHRN). In comparing of the rapid progress made in cancer research and treatment with the relatively slow progress in depression treatment, Dr. Simon noted the challenges of mental health research: the time necessary for discovery, the expense, the narrow focus, and the non-interoperable design structure. Dr. Simon discussed how the MHRN address these challenges, building on the Health Maintenance Organization (HMO) Collaboratory project funded through the NIH Common Fund. The MHRN is a consortium of 10 public-domain research centers affiliated with not-for-profit integrated health systems, with the mission of improving the management of mental health conditions through a closer connection between research, practice, and policy. He discussed the variation in health system structure (i.e., traditional, mixed model, and hybrid) and the benefit of including each in the Network. He also detailed key components of the MHRN infrastructure, including the development of a common electronic medical record system and a virtual warehouse for storing historical data; the creation of a shared infrastructure for measurement assessment; the harmonization of procedures for protecting patients’ rights and privacy; and, the engagement of health care providers and delivery system leaders in dialogue about the transition of practice into research priorities. Dr. Simon introduced the concept of a learning health care system, as defined by the 2008 Institute of Medicine’s Roundtable on Evidence-Based Medicine, as a system in which “each patient-care experience naturally reflects the best available evidence, and, in turn, adds seamlessly to learning what works best in different circumstances.” He described the benefits and barriers of this structure for various stakeholders, including patients, providers, and health care organizations.
Mental Health Equity: A Global Perspective
Pamela Collins, M.D., M.P.H., Associate Director for Special Populations, and Director of the Office for Research on Disparities and Global Mental Health (ORDGMH) and the Office of Rural Mental Health Research, talked to Coalition members about how health equity relates to global mental health. She cited Koplan and colleagues’ (2009) definition of global health as “an area for study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide,” and discussed how the increasing diversity in the United States population reminds us that we can contribute to and learn from the global health arena. Mental health needs abound for underserved individuals in high-income as well as low- and middle-income countries. She told Coalition members that although mental illnesses significantly contribute to the global burden of disease, few countries have adequate programs or professionals in place to address the growing needs. Only recently have low-income countries started to invest in mental health resources. Dr. Collins discussed how an investment in global mental health research is an opportunity to support a wider breadth of research in various settings and to answer critical questions using data from varied populations and cultural settings. She detailed the work that ORDGMH is doing to enable mental health researchers to attack problems of health disparities through in-depth understanding and investigation of social, environmental, and biological mechanisms in multiple settings. In closing, Dr. Collins highlighted NIMH efforts over the last year and a half to:
- Focus on equity to address the treatment gaps in low- and middle-income countries;
- Engage the global mental health community in priority setting;
- Engage the US disparities community in bridging the gaps;
- Support research capacity-building in global mental health; and,
- Support diversification of the US mental health research workforce.
Neurodevelopmental Genomics: Trajectories of Complex Phenotypes
Raquel E. Gur, M.D., Ph.D., the Karl and Linda Rickels Professor; Vice Chair, Research Development Departments of Psychiatry, Neurology and Radiology; at the University of Pennsylvania Medical Center provided an overview of the Developmental Genomics Project, a research project funded through the American Reinvestment and Recovery Act of 2009 (ARRA). She told Coalition members that pediatric medical records often lack information on behavioral development and stressed the importance of establishing developmental trajectories for mental disorders that often onset between childhood and young adulthood. To do this, the Project aims to establish multi dimensional measures to dissect complex phenotypes, and review and aggregate large samples, phenotypes, and electronic medical records to integrate data with genomics information. She briefly explained how her team is working with the Children’s Hospital of Philadelphia to conduct a random longitudinal study of 10,000 children, ages 8–21 years. The participants have already provided blood samples for genotyping and have granted access to electronic medical records. Researchers conduct interviews, administer a computerized cognitive battery, and use neuroimaging to study brain structure and function associated with behavioral dimensions that indicate vulnerability. Dr. Gur noted the diversity of the research sample (50 percent Caucasian and 38 percent African American), interview methods employed, and the importance of using the same structural MRI and functional MRI scanners to collect consistent images from all participants. She shared preliminary data showing that when classified by age, young females exhibit more severe anxiety and depression symptoms than males, and emphasized the need to link substance use data for youth aged 1–21 years with depression, attention deficit, psychosis, and anxiety data. The data set will be integrated with genomics. Once completed, the project will establish a publicly accessible resource for use in future research.
Coalition members actively engaged speakers in dialogue about their presentations. In response to Dr. Simon’s presentation, participants inquired—in the context of the current debate over comparative effectiveness research—how a move toward more personalized medicine will affect the costs of treatment. He stated that while personalized medicine can be more expensive, it would be much more effective to have a treatment that is known to work for an individual rather than spending time and money on something that may not work, and which may be more expensive in the long term. Dr. Collins queried Coalition members of their interests in the field of global mental health study. Participants responded that while there is interest within their organizations, many do not have existing collaborations in this area. Dr. Insel noted that he hopes that hearing what NIH/NIMH is doing in global health may bring about a sense of opportunity concerning research that is becoming available. Participants inquired what will happen to the staff employed to conduct the Developmental Genomic Project once ARRA funding runs out. Dr. Gur replied that some staff members will become unemployed, but many will go onto graduate programs or move onto other research opportunities, and others will be reassigned to other grants at the University. Participants also inquired about imaging data showing the trajectories of various disorders in sub populations. Dr. Gur said that she is currently looking at initial findings in this area.