Message from the Director
It is an exciting time to be at the helm of the National Institute of Mental Health (NIMH), the lead federal agency charged with setting and supporting the national agenda for mental health research. Scientific advances are rapidly transforming neuroscience and mental health care. Just in the last five years, we have made considerable progress. In basic science, the genetic revolution has begun to pay off for mental health research – after facing some challenges, we have now identified hundreds of places in the genome irrefutably linked to mental illnesses like schizophrenia, autism, and depression. The NIH Brain Research through Advancing Innovative Neurotechnologies® (BRAIN) Initiative has fostered the development of new tools and resources that have dramatically increased our ability to study the exquisite complexities of the living brain. In translational sciences, we celebrated the U.S. Food and Drug Administration (FDA) approval of two of the first truly novel antidepressants in decades – esketamine for treatment-resistant depression, and brexanolone for postpartum depression. And in intervention research, NIMH-sponsored studies proving the utility of coordinated specialty care for first episode psychosis resulted in the nationwide implementation of this evidence-based care model through state-supported mental health clinics.
The future is bright. Looking forward to the next five years and beyond, the new NIMH Strategic Plan for Research aims to build on these advances. Over the next few years, we look forward to the implementation of suicide prevention efforts based on recent NIMH findings. These include studies demonstrating the benefit of universal screening for suicidality in emergency departments, and the development of computational approaches to predict suicide risk using electronic health records and other digital tools. NIMH is also investing in research that examines and applies mental health care delivery systems in real-world settings. For example, NIMH is pioneering the Early Psychosis Intervention Network (EPINET), a research network that will use data from community-based first episode psychosis clinics to enhance the delivery, evaluation, and continual improvement of evidence-based care. These continuous developments drive the enthusiastic and energetic efforts of the research workforce devoted to our mission. And, more importantly, they offer hope and solutions to individuals with mental illnesses, as well as their families and communities.
Nonetheless, we face significant challenges. Studies of the origins of mental illnesses suggest that a combination of causes — genetic, environmental, social, and psychological — act on the brain through a complex web of interactions, resulting in a set of heterogeneous and overlapping illnesses. Deciphering the meaning and mechanisms behind these causes remains a daunting task. Accurate, replicable diagnosis continues to pose a challenge to scientists who are seeking to understand the nature of mental illnesses and develop new treatments. Stigma can further hinder clinical diagnosis and treatment engagement. The disability and financial burden associated with mental illnesses remain stubbornly high. One particularly tragic example: the rates of death by suicide have been rising for nearly 20 years across all age groups, genders, races, and ethnicities. Access to affordable and effective evidence-based care is inadequate and inequitably distributed.
These challenges must be met by harnessing promising opportunities. The NIMH Strategic Plan for Research maps out our path. From basic research aimed at understanding how the brain produces behavior, to translational efforts to uncover novel treatment targets, to clinical studies testing novel approaches, we’ve charted numerous routes linking these challenges and opportunities. Each has the potential to deliver significant advances in mental health care. NIMH’s broad portfolio aims to ensure that our research will have public health impacts across a range of timeframes—from the near-term to the far-off future. At NIMH, we’re proud of how far we’ve come, humbled by the distance yet to be traveled, and empowered by the hope that drives us forward.
Joshua A. Gordon, M.D., Ph.D.
Director, National Institute of Mental Health