NIMH Alliance for Research Progress Meeting
Location: Rockville, MD
The National Institute of Mental Health (NIMH) convened the twenty-third meeting of the Alliance for Research Progress (Alliance) on Friday, September 23, 2016, in Rockville, Maryland. The purpose of Alliance meetings is to foster dialogue, so that participants can directly hear about NIMH activities—including scientific advances, research projects, and a variety of ongoing and new initiatives of the Institute. Alliance meetings also provide opportunities for attendees to network with their colleagues in the advocacy community in person and to interact directly with senior NIMH staff. The new NIMH Director, Joshua Gordon, M.D., Ph.D., participated and Bruce Cuthbert, Ph.D., who had been serving as Acting Director, presided. Invitees included leaders from national mental health-related organizations representing and advocating for patients and their families. Screening for teens at risk for suicide, improving outcomes for youth with bipolar disorder, suicide prevention after jail detention, as well as an update on the Precision Medicine Initiative (PMI) were presented and discussed at the meeting. For more information on the speakers, please see the attached agenda and participant list.
Welcome and State of the NIMH
Bruce Cuthbert, Ph.D., Director, NIMH Research Domain Criteria (RDoC) Unit
Dr. Cuthbert updated participants on NIMH news, noting that the Institute budget for fiscal year 2016 is $1.5 billion. This figure represents a general increase of 3.9 percent, with additional funds for special initiatives. After providing NIMH staff and other updates, Dr. Cuthbert explained that the National Advisory Mental Health Council (NAMHC) has formed three Workgroups to: (1) review the opportunities and challenges of using new information technologies to study human behaviors relevant to the NIMH mission; (2) develop a list of recommended tasks and measures for each of the RDoC constructs; and (3) screen proposed changes to the RDoC matrix. He updated participants on the progress achieved by these groups. Dr. Cuthbert also highlighted recent advances in mental health science. For example, the results from the Recovery After an Initial Schizophrenic Episode (RAISE) study indicate that coordinated specialty care for first episode psychosis is associated with improved quality of life. This finding has given rise to the Early Psychosis Intervention Network (EPINet). Working with the Substance Abuse and Mental Health Services Administration, NIMH is helping implement specialty coordinated care in states. Centers within the EPINet are submitting data to NIMH and are receiving feedback so that they form a learning healthcare network. Dr. Cuthbert also reviewed recent and upcoming high-level events related to mental health and several other NIMH projects.
Dialogue with the Director
Joshua Gordon, M.D., Ph.D., Director, NIMH
Dr. Gordon praised Dr. Cuthbert and other staff members for shepherding the Institute during the past year and remarked that NIMH is in great shape. After describing his background, Dr. Gordon remarked that he wants to learn from Alliance and everyone involved with NIMH to discover what is working and what could be improved. He noted the need for a balanced NIMH research portfolio—including long-term investments in neuroscience to generate transformative treatments, mid-term investments with the capacity for translation within 2 decades, and short-term investments to influence treatment patterns and practice in the next 3 to 5 years (e.g., projects akin to RAISE). Dr. Gordon commented that although he has not yet formulated specific priorities, he has interests in several areas. These include integrating mathematics and computational principles into psychiatry, using new technologies to advance the basic science of neural circuits, and opportunities to apply evidence in the clinical sphere to achieve immediate improvements in care. On a personal note, Dr. Gordon said that he was excited to join NIMH and was happy to return to Maryland, as he is originally from the area.
Emergency Department Screening for Teens at Risk for Suicide (ED-STARS)
Cheryl King, Ph.D., Professor, Departments of Psychiatry and Psychology, University of Michigan
Dr. King commented that suicide is the second leading cause of death among people ages 12 to 24 in the United States and that many youths who die by suicide have never received any mental health services. There are several approaches to screening youths for suicide risk, but Dr. King concentrated on programs implemented in emergency departments (EDs). A substantial minority of children ages 12 to 17 visit an ED each year. The NIMH-funded ED-STARS research project aims to determine an optimal suicide risk screening strategy for youth ages 12 to 17 who present to pediatric emergency departments. The project is designed to develop a personalized, efficient screen for imminent and moderate suicidal risk that has the potential to streamline assessment in the emergency department. With such a screen in place, providers could rapidly match patients to the needed level of care and identify modifiable risk factors to target in subsequent treatment. If implemented on a wider scale, emergency department screening for adolescent suicide risk could reduce the rate of youth suicide attempts.
Update: NIH Precision Medicine Initiative
Eric Dishman, Director, Precision Medicine Initiative Cohort Program, NIH
Mr. Dishman commented that his experience is rooted in patient advocacy, and he shared his personal story as a cancer patient who experienced early precision medicine. The PMI Cohort Program will involve one million or more voluntary participants who reflect the broad diversity of the United States. It provides opportunities for volunteers to provide data on an ongoing basis. The PMI Cohort Program is not a study on one disease but a data resource to inform many research studies on a wide variety of health conditions. In this initiative, NIH is also taking a transformational approach to participation, as individuals in the PMI Cohort Program will be true partners in the research process and will have access to the data. The privacy and security will be of the highest standard. Diverse researchers—including citizen scientists—will be able to analyze the data. The PMI Cohort Program website will soon have more information for community organizations that are interested in helping with enrollment. Dr. Gordon stressed that it is critical to involve people with mental health conditions in the PMI Cohort Program.
Improving Outcomes for Youth with Bipolar Disorder
Tina Goldstein, Ph.D., Associate Professor, Co-Director, Clinical Psychology Internship Training Program, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center
Early-onset bipolar disorder is highly recurrent, with more than 60 percent of patients relapsing over 4 years. Those affected have increased risk for negative outcomes, such as substance use, high-risk behaviors, and suicidal behavior. The Child and Adolescent Bipolar Spectrum Program is studying psychosocial treatment of early-onset bipolar disorder—including intensive (dialectical behavioral treatment [DBT]) and brief (motivational intervention [MI] to improve medication adherence) therapies. DBT is a skills-based treatment originally developed for adults with borderline personality disorder that has been linked with reduced suicidal behavior, hospitalizations, and substance use. An open pilot study of DBT for adolescents with bipolar disorder showed positive outcomes. Currently, a larger controlled trial is underway (the WAVE Therapy Study) to compare these two therapies.
Additionally, the team recently completed a randomized trial examining the efficacy of MI for improving medication adherence among adolescents with bipolar disorder is a developmentally appropriate intervention that meets a great clinical need, as there is only an approximately 35 percent adherence rate among this population. Improving adherence may hold great potential for enhancing outcomes.
Suicide Prevention After Jail Detention: An Understudied Area of Critical Importance
Jennifer Johnson, Ph.D., Associate Professor, Co-Director, Clinical Psychology Internship Training Program, Western Psychiatric Institute and Clinic University of Pittsburgh Medical Center
Lauren Weinstock, Ph.D., Associate Professor, Department of Psychiatry and Human Behavior, Brown University
Dr. Johnson provided an overview of the U.S. criminal justice system. More than 15 million people pass through this system each year. In the United States, the criminal justice system is a catchment area for individuals at high risk for health problems (e.g., HIV, tuberculosis, hepatitis). Among incarcerated individuals, 56 percent have mental disorders and 66 percent have substance use disorders. Most incarcerated individuals move back quickly to communities, which bear the economic cost of their untreated health problems.
Dr. Weinstock explained that the Suicide Prevention Intervention for at-Risk Individuals in Transition (SPIRIT) Trial is the first randomized study of any intervention for suicide risk reduction following release from jail. As the average rate of death by suicide in this first post-release year is approximately 10 times the rate reported in the general population, the purpose of the study is to reduce suicide in the community. If the intervention is as effective in jail detention as it is in the emergency department, the implementation in these settings could prevent 5 to 9 percent of all suicides in the United States.
Dr. Gordon encouraged dialogue on topics of interest to participants. Alliance members commented on the need to treat the whole person rather than a specific condition. Alliance members also discussed suicide, including the need to study the basic neuroscience of emotional pain, and why people feel disconnected from others. Participants highlighted the importance of building communities that enhance mental health protective factors. The dialogue also touched upon the need for more precise psychiatric diagnoses and the timeframe for RDoC. Dr. Cuthbert commented that RDoC staff members have discussed issues that cut across diagnoses (e.g., suicide and impulsivity), and NAMHC Workgroups are also focused on advancing RDoC. An upcoming meeting of RDoC researchers will feature results from the first round of studies. Dr. Cuthbert remarked that it would be helpful to hear Alliance members’ thoughts on RDoC.
Alliance members discussed the need to convey progress in the mental health field to members of the general public. After discussion, Dr. Gordon suggested three major points to convey progress in mental health to the public: (1) researchers are learning an incredible amount about the brain, which will help them develop next-generation treatments; (2) they are developing current treatments into transformative ones; and (3) they are determining the best ways to implement effective treatments in the community. Both Drs. Gordon and Cuthbert thanked Alliance members for their participation and commented that they look forward to working with them.