Outreach Partnership Program 2019 Annual Meeting: Overview
July 31 - August 1, 2019
On July 31 and August 1, 2019, the National Institute of Mental Health (NIMH) convened the annual meeting of the NIMH Outreach Partnership Program (OPP), a nationwide initiative seeking to increase the public’s access to science-based mental health information. The gathering provided an opportunity for the program’s Outreach Partners, heralding from every state, the District of Columbia, and Puerto Rico, and National Partners to hear updates from NIMH leadership, to learn about NIMH-supported research, and to discuss the mental health needs of their constituents with NIMH staff and their fellow Partners.
In his opening address, NIMH Director Joshua A. Gordon, M.D., Ph.D., updated attendees on NIMH priorities, science planning activities, and cross-National Institutes of Health (NIH) initiatives. He discussed the updated version of the Strategic Plan for Research, which will be released in 2020. Dr. Gordon highlighted the ongoing activities of the Interagency Autism Coordinating Committee and reviewed NIMH research in areas such as suicide prevention, antidepressant medication development, and learning networks for early psychosis treatment. Dr. Gordon also updated the participants about ongoing activities across NIH, including The Brain Research through Advancing Innovative Neurotechnologies® (BRAIN) Initiative; the Helping to End Addiction Long-termSM Initiative, or NIH HEAL InitiativeSM; the HEALthy Brain and Child Development Study; and the All of Us Research Program. These programs represent a critical component of NIH’s ongoing efforts to support effective, evidence-based health care across diverse populations.
Natalie Zeigler, chief of the Science Writing, Press, and Dissemination Branch within the NIMH Office of Science Policy, Planning, and Communications, concluded the introductory portion of the meeting with a brief overview of NIMH resources that partners and other stakeholders can use for their outreach and education efforts, including newsletters (such as Discover NIMH and Inside NIMH), brochures and fact sheets, social media, podcasts and videos, and a new online education and awareness portal.
Postpartum Depression Care and Prevention
Approximately 1 in 9 women in the United States (U.S.) experience postpartum depression (PPD). Of those, only about half will seek treatment. As a result, researchers are motivated to discover innovative treatments and interventions to help women who suffer from this debilitating condition.
Peter Schmidt, M.D., chief of the NIMH Behavioral Endocrinology Branch, reviewed his research on PPD and neurosteroids, hormones synthesized naturally in the brain that act as part of the central nervous system. He explained that sudden fluctuations in certain neurosteroids, such as allopregnanolone, can trigger or worsen PPD. Medications that regulate these hormones may improve overall mood in women who are susceptible to PPD, but researchers are still unsure which combinations and dosages of neurosteroids work best to decrease symptoms of depression and anxiety in postpartum women. He also described the basic science discoveries made by NIMH scientists that laid the foundation for the development of brexanolone, the first medication approved by the U.S. Food and Drug Administration specifically for the treatment of postpartum depression.
Jennifer Johnson, Ph.D., C. S. Mott Endowed Professor of Public Health and Professor of OBGYN, Michigan State University, discussed her work on the Reach Out, stay Strong, Essentials for mothers of newborns (ROSE) Study, a postpartum depression prevention program for clinics providing prenatal care to low-income women. Dr. Johnson pointed out that 1 in 3 low-income mothers experience PPD, and the ROSES intervention fills a critical need to provide these women with education and skills to help them remain mentally well during and after pregnancy. Outcomes from clinical trials indicate that the ROSES program successfully reduces rates of PPD among disadvantaged mothers.
Research Response to the Opioid Public Health Crisis
In recent years, the U.S. has experienced an opioid crisis, caused in part by a lack of long-term strategies to address chronic pain management. The crisis has evolved from prescription opioid misuse to fentanyl misuse, and, accordingly, opioid-related deaths are steadily increasing—in fact, the national overdose death rate was 9.6 percent higher in 2017 than it was in 2016.
Rebecca Baker, Ph.D., director of the NIH HEAL Initiative, expanded on the initiative and the program’s response to the ongoing opioid crisis. The initiative is an aggressive, trans-NIH effort to speed scientific solutions to stem the national opioid public health crisis. Launched in April 2018, the initiative is focused on improving prevention and treatment strategies for opioid misuse and addiction and enhancing pain management. The NIH HEAL Initiative also supports other programs, such as the HEALing Communities Study, which address opioid misuse in vulnerable populations, including children, mothers, and individuals involved with the criminal justice system. The Early Phase Pain Investigation Clinical Network contributes to this mission by accelerating early-phase testing of non-addictive pain management treatments. Other ongoing research programs in this area include studies about different types of pain, pain treatment options, and ways to integrate these interventions in clinical settings.
In the fourth talk of the meeting, Michael Schoenbaum, Ph.D., Senior Advisor for Mental Health Services, Epidemiology, and Economics in the NIMH Division of Services and Intervention Research, elaborated on the collaborative care component of the NIH HEAL Initiative. The collaborative care approach aims to equip primary care providers with the tools they need to provide their patients with effective, evidence-based treatments. Currently, many providers are not authorized to prescribe promising drug interventions, such as buprenorphine, to their patients with opioid use disorders. The NIH HEAL Initiative’s collaborative care model addresses such problems by ensuring that primary care includes a behavioral health care manager, an advisory specialty consultant (such as a psychiatric clinician), and a registry to effectively document treatments and outcomes. This cost-effective model is covered by primary care and a small number of Medicaid programs, and preliminary data from the initiative suggest that the efforts have already streamlined treatment and improved outcomes for patients with opioid use disorders.
Community-based Models to Support Individuals with Serious Mental Illness
Michael Compton, M.D., M.P.H., Professor of Clinical Psychiatry, Columbia University College of Physicians and Surgeons and Medical Director for Adult Services, New York State Office of Mental Health, presented on two studies on serious mental illness (SMI) that were recently conducted in Savannah, Georgia. The first of these was the Opening Doors to Recovery (ODR) Study, which has reduced hospitalizations and improved quality of life among patients with psychotic or mood disorders and a history of hospital recidivism. He predicts that patients who participate in the ODR program will be more likely to stay out of jail because their care support teams communicate with law enforcement. People with SMI—particularly those with psychosis—are known to experience high rates of criminalization, and their conditions often worsen after spending time in jail. The ODR program represents a critical step towards reducing criminal justice system involvement among people with SMI.
Amy Watson, Ph.D., Professor, Jane Addams College of Social Work at University of Illinois at Chicago, spoke further on this topic by reviewing her NIMH-funded studies, which focus on police response to individuals with SMI. Approximately 1 in 5 people with SMI will become involved in a police incident in their lifetime. In her research, Dr. Watson has found that people with SMI are less concerned about the outcome of a police interaction than they are about being treated fairly and with respect by authority figures. Police officers who take mental health calls report their top areas of concern as resistance and cooperation, presence of drug use, and visible signs and symptoms of mental illness. Officers who undergo Crisis Intervention Team training can more effectively de-escalate situations and provide mental health resources for people with SMI.
Joan Asarnow, Ph.D., Professor of Psychiatry and Biobehavioral Sciences and Director of the Youth Stress and Mood Program at University of California, Los Angeles, stated that suicide is the second leading cause of death in age groups across ages 10 to 34. She explained that only half of the children who are released from the emergency room after self-harm or a suicide attempt will receive follow-up treatment despite ongoing mental health needs. To address this gap in mental health care, researchers are studying interventions at the emergency department. These approaches include the SAFETY Program, which is a dialectical behavior therapy (DBT) informed approach incorporated with emergency mental health programs, and Step2Health, a randomized controlled trial comparing two Zero Suicide (ZS) strategies – ZS Quality Improvement plus stepped care for suicide prevention versus ZS Quality Improvement alone. She also discussed the CARES study, which provides a DBT approach combined with family involvement. These approaches have shown promising results in reducing self-harm. Finally, Dr. Asarnow reviewed their research efforts under the Garrett Lee Smith Memorial Program to support collaborative care within primary care clinics to not only identify at-risk children but to also monitor and return them to care when needed.
Lauren Weinstock, Ph.D., Associate Professor of Psychiatry and Human Behavior at Brown University, Providence, Rhode Island, reviewed three efforts that serve people who are at-risk for suicide during periods of transitions, such as the rapid transition into the community after inpatient care or the transition from incarceration. The Coping Long Term with Active Suicide Program, the Emergency Department Safety Assessment and Follow-Up Evaluation (ED-SAFE) study, and the Suicide Prevention Intervention For At-Risk Individuals In Transition (SPIRIT) study all aim to reduce the treatment barriers that people with SMI face during critical transition periods, such as cost, transportation issues, and missed appointments. These interventions deliver support and care coordination primarily by telephone and have shown promise in reaching these vulnerable populations. The research team is looking to broaden efforts across partnerships with local health care systems and within other vulnerable populations such as veterans.
Poster Sharing Sessions and Wrap-up
Outreach and National Partners convened to present posters about their ongoing outreach efforts to serve individuals with mental health needs. More than 55 partners shared their ongoing activities to promote health and wellness in diverse communities across the country. The poster sharing sessions fostered a lively dialogue among researchers, program partners, and other stakeholders, who expressed enthusiasm for the opportunity to share, learn, and collaborate about programs to enhance awareness and delivery of mental health services.
The Outreach Partnership Program has empowered a diverse array of researchers, partners, and agencies to collaborate in the spirit of scientific discovery and civic engagement. NIMH recognizes that a primary goal of research is to secure health and well-being for all communities, and they appreciate the opportunity to meaningfully support this urgent mission. Going forward, NIMH is launching a new comprehensive outreach effort to increase the public’s access to science-based mental health information. The NIMH encourages feedback and suggestions about NIMH’s outreach efforts via NIMHOutreach@mail.gov.