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Post by Former NIMH Director Thomas Insel: Looking Forward in 2010

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This week’s issue of Nature, the first of 2010, includes an editorial entitled “A Decade for Psychiatric Disorders”. Phil Campbell, the editor of Nature, argues that the understanding and treatment of conditions such as schizophrenia are ripe for a revolution. At NIMH, we agree with this assessment. Indeed, the revolution is already underway with extraordinary recent findings from genomics, imaging, and clinical trials. The banner for this revolution is pathophysiology, understanding the mechanism of disease as a critical step to developing novel, effective, and safe treatments and preventive strategies. As Campbell says, “There is much to be done, and a decade is the timescale over which enhanced commitment is required.”

What can we expect in 2010? In December, the President signed an omnibus appropriations bill that included a 2.7% increase for NIMH, with total funding of nearly $1.5B. This budget should allow us to fund between 15 and 20% of applications. We are projecting support of roughly 550 new research grants for 2010, which is close to the mean of the past 5 years. Please see the NIMH website for information about the Fiscal Year 2010 funding strategy. Our planning for 2010 will be shaped substantially by our efforts to capitalize and build on investments made using funds from the American Recovery and Reinvestment Act of 2009 (Recovery Act). Recovery Act funds have been used to jumpstart the NIMH Strategic Plan, which the Institute sees as a vehicle to facilitate priority setting, rapid exploitation of new scientific opportunities, and monitoring the public health impact of NIMH research.

I would like to draw your attention to two new areas of emphasis in 2010. Global mental health is an emerging area for NIMH, along with partners here at NIH as well as the World Health Organization (WHO).While global sometimes means foreign or international, at NIMH we think of global as part of our core public health mission in an increasingly inter-connected world. Unlike many infectious diseases, mental illnesses do not respect geographic boundaries. Discoveries about mood disorders or schizophrenia in other countries are discoveries that can change what we do here in the U.S. Global mental health offers NIMH access to the scientific opportunities and the public health needs that exist throughout the world, from children of conflict in Africa to population isolates in the Middle East to novel mental health delivery systems in Asia. A new office at NIMH, the Office for Research on Mental Health Disparities and Global Mental Health, under the leadership of Dr. Pamela Collins, will be developing initiatives in the coming months to focus on mental health disparities within our borders and beyond.

A second NIMH initiative is right out of the Strategic Plan. Diagnosis has been a chronic challenge for both research and treatment of mental illness. It has become increasingly clear that most of our diagnostic categories are heterogeneous, and most of our patients have “co-morbid” conditions. The Diagnostic and Statistical Manual of Mental Disorders, or DSM, has yielded improved reliability, but validity will require an approach based on pathophysiology, not clinical consensus. The Research Domain Criteria (RDoC) is an initiative that will develop neuroscience-based criteria for classifying mental disorders. RDoC is intended as a framework for the research community, providing translational scientists with new ways of organizing research based on dimensions of cognition or behavior that are linked to specific neural systems. Dr. Bruce Cuthbert,who recently joined NIMH, will be leading this effort, which we hope will involve most NIMH grantees, whether they are doing genomics, animal behavior, or clinical research. The RDoC process has been designed to be fully open and transparent, with initial comments solicited through an NIMH Request for Information followed by a series of conferences on various dimensions (such as executive functioning or fear circuitry) whose proceedings will be posted for further on-line discussion.

As the editorial in Nature says, this is an extraordinary time for research on mental illness, the beginning of a decade of discovery. We start 2010 looking forward to a year in which we will continue to fund even more research that makes a positive change in the lives of people affected by mental illness.