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Post by Former NIMH Director Thomas Insel: A Plan for Changing Times

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When I first determined back in 2013 that it was time for NIMH to update its Strategic Plan, I envisioned a simple “tune-up” and quick turnaround. It quickly became apparent that the mental health research landscape had seen vast changes since we published our plan in 2008. Instead of a tune-up we embarked on a complete re-examination of our priorities and the scientific opportunities that challenged us to look forward into the future.

In an era in which funding in terms of real dollars for research is declining, a strategic plan is an important tool for ensuring the best use of scarce funding. In 2008, when the first plan was issued, a global recession was underway, exacerbating a sense of crisis in science funding. The 2008 strategic plan would guide the use of funds from the American Recovery and Reinvestment Act in 2009; Recovery Act funding enabled the institute to jumpstart many of the goals laid out in that plan. Among the efforts the Recovery Act helped to fund: a broad range of grants related to autism, including efforts identified in the Interagency Autism Coordinating Committee’s own Strategic Plan for Autism Spectrum Disorder Research; creation of a transcriptional atlas of human brain development (highlighted in the current plan); and the Recovery After an Initial Schizophrenia Episode (RAISE) project.

The 2015 Strategic Plan for Research was developed during a quite different era. With parity and health care reform, the rise of mHealth and social media, new sources of research support and collaboration, and the advent of citizen science, NIMH needed to adapt to a new ecosystem. Ideas hatched from the earlier plan, such as the Research Domain Criteria (RDoC) project and experimental medicine trials, were now ready for full implementation. And topics which were barely noted in 2008, such as global mental health, prevention, and health disparities, have become cross cutting themes for NIMH.

What’s in the new plan? Like the 2008 edition, there are four strategic objectives. The first leverages recent progress in genomics, imaging, and cognitive science to define the biology of complex behaviors. The second objective, building on the concept of mental disorders as neurodevelopmental disorders, seeks to chart the trajectories of mental disorders to determine optimal times for intervention. The third objective uses discoveries from the first two objectives to focus on prevention and cures. In addition to calling for new treatments based on a precision medicine approach, this objective calls for moving trials into community settings. Finally, the fourth objective calls for increasing the public health impact of NIMH research through research on services and implementation to improve equity, access, and the quality of care.

The plan includes specific strategies for each of the four objectives and highlights of recent research that exemplify how science in each area can make a difference. Each objective links to a set of detailed research strategic priorities for funding that provide scientists with a more granular explanation of what the Institute plans to fund. As with the 2008 plan, our intent is to use the new Strategic Plan for Research as a guide for new initiatives and for making funding decisions.

My hope is that this plan will be a framework for mental health research to make the fastest possible progress, and the greatest possible contribution to public health, in a swiftly changing world. Our success will not be measured in number of grants or number of papers. Our success needs to be measured by changes in morbidity and mortality. This strategic plan needs to “pave the way for prevention, recovery, and cure.”