The National Institute of Mental Health (NIMH) has just entered its 66th year as the Nation’s leader in research on mental disorders, supporting research to transform the understanding and treatment of mental illnesses, paving the way for prevention, recovery, and cure. Over the past 6 years, we have seen progress in many areas, from fundamental neuroscience to research on service delivery. We have seen breakthroughs in genetics, the launch of the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative, and the success of the Human Connectome Project. We have completed a study of risk and resilience in over 100,000 soldiers and developed the Early Psychosis Prediction and Prevention (EP3) program to prevent the onset or reduce the duration of untreated psychosis. When we compare these accomplishments against our goals in the 2008 Strategic Plan, we see what forward planning can accomplish. While there has been progress, we believe much more is possible. This update of our Strategic Plan is a commitment to take a fresh look at our horizons so that we can refine priorities and energize our path of discovery.
We know that some scientists reject the concept of “directed science,” believing that science rarely follows a plan. True, important discoveries often result from serendipity or side roads rather than a premeditated, carefully articulated strategy. On the other hand, these “eureka moments” come to those working on tough problems. A strategic plan can identify the most important problems and identify areas of traction. And for our science to affect policy or practice, a plan may be essential. In fact, the right plan can serve both scientific discovery and public health needs. With this realization in mind, and with the guidance of the National Advisory Mental Health Council and our public stakeholders, we updated the 2008 Strategic Plan. During this process, we heard three questions repeatedly:
First: How do we balance urgent mental health needs with longer-term investments such as basic research? The unavoidable tension between patients’ urgent needs today and the promise of basic science progress on the horizon is daunting and particularly critical with limited funds. In fact, we need to focus on both near-term and long-term objectives. Near-term needs can be pursued strategically through targeted funding announcements with deliverables and timelines. Our longer-term objectives are best pursued via supporting investigator-initiated proposals based on scientific opportunities that lead to fundamental discoveries. But we avoid investing research dollars based on a predetermined formula of short-term versus long-term impact.
Second: How do we link advances in biology (e.g., genomics, neuroscience) with the range of environmental factors (e.g., stress, social determinants) that influence mental disorders? While the tools of genomics and neuroscience now permit rapid progress, equivalent tools and paradigms to study environmental influences are just being developed. Over this next 5-year period, we can expect this new approach to environmental factors, sometimes called the exposome, to yield more scientific traction in understanding the mechanisms by which environmental factors alter brain and behavior, from prenatal development through the process of aging.
Third: What are the metrics of success? That is, how will NIMH know whether and when it has met its goals? While the discovery phase of science may not lend itself to timelines and milestones, being more strategic in our planning necessitates accountability. Our success cannot be measured solely by traditional academic “outputs”: the numbers of grants supported or papers published. Our success needs to be assessed by “outcomes”: how well the research we support changes our understanding of brain and behavior, improves our diagnostic system, provides effective treatments, supports prevention of mental disorders, eliminates the disparities in underserved populations, and reduces premature mortality among persons with mental illnesses. We will position ourselves to collect the appropriate metrics to provide credible answers to these and other important questions.
This Plan is our commitment to accelerate the pace of scientific progress by generating research over the next 5 years that will have the greatest public health impact and continue to fuel the transformation of mental health care. We at NIMH trust that you find the prospects as exciting and important as we do.
Thomas R. Insel, M.D.