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Transforming the understanding
and treatment of mental illnesses.

Director's Message

Steps Toward Equity at NIMH: An Update


Last year, I wrote about how the death of George Floyd served as a wake-up call to me personally and to others in the NIMH community. Throughout the past year, we have been working to make lasting change in our organization, striving to identify and address the extent to which our policies, procedures, and culture serve to perpetuate the status quo and working to promote anti-racist ideas and actions. Although we have a long way to go, I am writing now to provide an update on what we’ve done so far and what we plan to do in the future.

As NIMH Director, I made a commitment to reevaluate and expand our research efforts related to mental health disparities. Accordingly, we conducted a year-long series of workshops and seminars bringing experts in the field together to help formulate a path forward. Following on these discussions, we have articulated a framework for health disparities research that emphasizes community engagement and a focus on the social determinants of health. This framework has now been presented publicly on the NIMH website: NIMH’s Approach to Mental Health Disparities Research. There we identify five specific priority areas, including youth suicide in Black and other minoritized communities; population-based studies; mechanism-based intervention development and testing; implementation science; and integrated, multi-stakeholder approaches to research.

We’ve also been taking a hard look at how our grant-making process affects the diversity of our scientific workforce. In particular, we have focused our early efforts on the differential award rates for grant applications supporting Black investigators and white investigators. One of our first tasks was to carefully examine how applications supporting Black and white principal investigators (PIs) moved through the various stages of the grant review process. Thanks to the hard work of a dedicated team of NIMH staff1 who combed through over a decade’s worth of application data, we learned that applications supporting Black investigators are disadvantaged at each stage of the process (Figure 1). These applications were less likely to be discussed by review committees, less likely to receive a good score if discussed, and less likely to be funded if not assigned a good score, compared to applications not supporting any self-identifying Black investigators.

Application Review Process: Applications received, discussed, scored, awarded, and resubmitted that supported at least 1 Black PI and no Black applicants, 2008-2019
Figure 1. Application Review Process: Applications received, discussed, scored, awarded, and resubmitted that supported at least 1 Black PI and no Black applicants, 2008-2019. See Methods page for additional information.

Solutions designed to reduce these disparities thus have to be aimed at each stage. To address issues in review, we’re publicizing these data to increase awareness in the community. We’re also working with the Center for Scientific Review (CSR) to increase the diversity of reviewers by increasing outreach and through targeted recruiting efforts to diversify the pool of prospective panel member candidates. CSR is also rolling out anti-bias training to reviewers. To ensure equity in the decisions we make at NIMH once grants are scored, we added additional steps to our own decision-making processes to reduce the potential for bias and ensure that diverse scientific perspectives are appropriately valued. Early returns seem to suggest these changes are making a difference. As I presented at the National Advisory Mental Health Council in September, funding rates through Fiscal Year 2020 demonstrate a narrowing of the funding gaps between applications that support Black and white PIs compared to previous years (Figure 2).

NIMH funding rate among applications supporting white PIs and Black PIs, 2011-2020
Figure 2. NIMH funding rate among applications supporting white PIs and Black PIs, 2011-2020. See Methods page for additional information.

The internal environment at NIMH is also a focus of our attention. I want to ensure that everyone who works at NIMH, regardless of background, experiences our Institute as welcoming and inclusive, and that our recruitment, promotion, and retention practices are equitable. To help me make concrete changes to promote equity, diversity, and inclusion, I formed an Anti-Racism Task Force, composed of individuals from across NIMH, including a broad array of scientists, administrative staff, trainees, and others, with both senior and junior NIMH staff participating. The task force presented me with a series of recommendations, which included increased transparency of data on demographics in our workforce; accountability for ensuring equitable promotions, awards, and other career advancement opportunities; enhanced training and mentorship opportunities; and infrastructure and support for ongoing workforce diversity efforts.

Per these recommendations, we are moving forward with facilitated internal listening sessions so that NIMH staff have the chance to voice their experiences of working at NIMH. We’ve also added performance elements for supervisors that ensure that their efforts to create an equitable and inclusive atmosphere for their employees are incorporated into their yearly evaluations. And we will soon begin a search for a Chief Diversity Officer at NIMH who will report directly to me and be endowed with sufficient staff and financial resources to support a sustained effort of culture change both inside and outside of NIMH.

These are just some of the changes underway at NIMH, and we recognize this will be more of a marathon than a sprint. But I promised action a year ago and I want to make sure the NIMH stakeholder community knows what we’ve been doing. Every one of us has a role to play in this effort and I will continue to hold myself accountable for ensuring change happens.

1 NIMH staff who contributed to these analyses include Ishmael Amarreh, Ph.D., Elan Cohen, M.S., Dawn Morales, Ph.D., Uma Vaidyanathan, Ph.D., Abera Wouhib, Ph.D.