Blog Post » A Plan for Mental Health Research

There he is! Strains of “Pomp and Circumstance” are drowned out by applause as soon as my wife and I recognize our son’s name. Four years of diligent planning and working hard culminates in this moment as he strides across the stage … or rather, as his name slides slowly across our television screen. Welcome to College Graduation 2020: Coronavirus (COVID-19) edition. While many of his plans came through — he worked hard at his studies, busied himself with internships and part-time jobs, made deep friendships — not all of our son’s plans worked out. Certainly, he did not plan on his last two months of college going online, his only opportunity to say goodbye through Zoom, and his graduation ceremony, speakers and all, happening on YouTube. Yet the core of those plans worked out — and my wife and I couldn’t be prouder of what he’s accomplished, and we look forward with excitement to what he’ll do next.

A box of celebratory doughnuts

A box of celebratory doughnuts.

The COVID-19 pandemic has highlighted the uncertainties we all face, but also the value of a good plan. A good plan assesses where you’re at and identifies where you want to go. It sketches out a pathway to get there and identifies priorities, opportunities, and anticipated pitfalls. But, as COVID-19 has reminded us, a good plan also remains flexible, because you never really know what you’ll encounter along the way.

This week, during Mental Health Awareness Month, the National Institute of Mental Health (NIMH) is unveiling its own plan: the new NIMH Strategic Plan for Research. We’ve been working hard on this iteration of the Strategic Plan for the past year — the last two months, like many of you, through teleworking at home — and we’re pleased to be able to release the final version. The Plan starts with where we currently are, recognizing the advances in knowledge and treatment that got us to where we are today. It reiterates where we want to go–towards prevention, recovery, and cures for mental illnesses. And with some new features, it seeks to enshrine the flexibility necessary to ensure we stay on the cutting edge.

At the centerpiece of this Plan is the notion that biomedical research is critical to the understanding and treatment of mental illnesses. We can see this by looking back at what we have accomplished in just the past five years since the last iteration of our Strategic Plan. Research is rapidly transforming the understanding and treatment of mental illnesses across a broad range of disciplines. In genetics, we have identified hundreds of places in the genome linked to mental illnesses, such as schizophrenia, autism, and depression. In basic neuroscience, 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, thanks to the hard work of many NIMH-funded investigators, the U.S. Food and Drug Administration (FDA) has approved two of the first truly novel antidepressants in decades — esketamine for treatment-resistant depression, and brexanolone for postpartum depression. And in services 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.

Looking forward to the next five years and beyond, the NIMH Strategic Plan for Research aims to build on these advances. Integrating input from a broad coalition of stakeholders, including individuals with lived experience, families, providers, advocates, scientists, federal partners, and more, we’ve attempted to identify areas where NIMH-funded science can have the greatest impact. The Plan outlines four high-level goals, which form a broad roadmap for the Institute’s research priorities over the next five years. These goals are:

We will further these goals by supporting investigator-initiated research and through targeted funding announcements. We will also take into account cross-cutting themes — like the need to continue to expand computational and theoretical approaches and to emphasize reaching underserved communities — that inform research throughout our portfolio.

Built into this Strategic Plan are some novel features to ensure that we maintain the flexibility we’ll need to keep pace with ever-evolving scientific approaches and research priorities that may lead to new discoveries. Unlike prior Strategic Plans, which have been static documents, the new NIMH Strategic Plan for Research will be a web-based, living document. This will allow us to highlight key research projects and findings from NIMH and NIMH-funded investigators that advance the Institute’s mission on a linked Progress page for each goal. These Progress pages will allow our stakeholders to follow our scientific advancements over time. The Strategic Plan itself will be updated regularly as we identify and prioritize new opportunities.

At NIMH, we’re incredibly excited about the progress we’ve been making and even more excited to put this Strategic Plan into action. Carefully executed, the Plan should continue to drive the enthusiastic and energetic efforts of the research workforce devoted to our mission. More importantly, it should offer hope and solutions to individuals with mental illnesses, as well as their families and communities. Finally, it should be flexible enough to deal with whatever comes our way over the next five years. We may not have a graduation ceremony at the end, but like my son, we’ve still got plenty to look forward to.

Original Article

Science News » New NIMH Strategic Plan Paves the Way for Advances in Mental Health Research

The National Institute of Mental Health (NIMH) has released its Strategic Plan for Research. The new plan provides a framework for advancing research priorities that support the Institute’s mission: To transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery, and cure.

“Mental illnesses are common in the United States, affecting tens of millions of people each year,” said NIMH Director Joshua Gordon, M.D., Ph.D. “Improving treatment for people with mental illnesses will depend on continued research to define the biological underpinnings of these disorders, as well as ongoing translational and clinical research to turn that knowledge into new or improved treatment options.”

Over the past five years, NIMH-supported research has revealed hundreds of places in the genome linked to mental illnesses; fostered the development of new tools and resources that have dramatically increased the ability to study the brain; played a role in the development of two novel antidepressants; and proved the utility of coordinated specialty care for first-episode psychosis—resulting in nationwide implementation through state-supported mental health clinics.

“Through this new plan, we aim to build on these advances, identify areas where NIMH-funded science may have the greatest impact, bridge research gaps, and support novel approaches that further accelerate mental health research,” added Dr. Gordon.

The new NIMH Strategic Plan for Research builds on the successes of previous NIMH strategic plans by providing a framework for scientific research and exploration and addressing new challenges in mental health.

The Strategic Plan outlines four high-level goals:

  • Goal 1: Define the Brain Mechanisms Underlying Complex Behaviors
  • Goal 2: Examine Mental Illness Trajectories Across the Lifespan
  • Goal 3: Strive for Prevention and Cures
  • Goal 4: Strengthen the Public Health Impact of NIMH-Supported Research

These four Goals form a broad roadmap for the Institute’s research priorities over the next five years, beginning with the fundamental science of the brain and behavior, and extending through evidence-based services that improve public health outcomes. The new Strategic Plan for Research retains the core elements of previous NIMH Strategic Plans. It has been revised, updated, and expanded in response to the many discoveries and changes in the field.

The Strategic Plan for Research will be updated regularly to keep pace with ever-evolving scientific approaches and research priorities that may lead to new discoveries. Key research projects and findings from NIMH and NIMH-funded investigators that advance the Institute’s mission will be highlighted on a Progress page for each goal.

NIMH developed the Strategic Plan with input from a variety of stakeholders, including NIMH leadership and staff, the National Advisory Mental Health Council, federal and private partners, as well as feedback from organizations, advocacy groups, and people with lived experiences and their families via a Request for Information seeking public comment.

“Over the last decade, we’ve seen incredible scientific advances that have rapidly transformed neuroscience and mental health care,” said Dr. Gordon. “While there is still more work to do and challenges ahead, the future is bright.”

The NIMH Strategic Plan for Research is available online at www.nimh.nih.gov/strategicplan.

Original Article

Blog Post » The Kindness of Strangers: Supporting Each Other During COVID-19

A few weeks ago, a couple of weeks into social distancing, my wife and I were walking our dog Zoey on a drab Friday morning. It had been a challenging week, and my mood was not particularly good. We went down the street to our car, which my wife was going to take to work — an essential New York City employee, she still has to go to work in person some days. She got in the car and started to drive off before suddenly pulling over and pointing at what used to be the passenger side mirror. It had been stolen. So had nearly every other passenger side mirror in a long row of cars in front and in back of ours. Thieves had taken advantage of the fact that people are using their cars less under the stay-at-home order. My wife gingerly drove off without the mirror, but I just sat down right there, stunned and overwhelmed. Amidst all that was going on, opportunistic ugliness revealed itself. Not for the first time since COVID-19 came along, I unsuccessfully fought off tears.

Now, as I write this a few weeks later, I’m reminded of another time I sat on a street corner, overwhelmed. On Saturday, July 6, 2013, I was bicycling through central Kansas on a 97-mile journey from Dighton to Great Bend. The last leg of the ride looked to be a 32-mile slog without services, according to what my navigation app told me over lunch at a diner in Rush Center.

The ride was hot, and I was working hard against the wind, sucking down water that was becoming warmer by the minute. As I rolled into a small town called Albert halfway to my destination, I was desperate for a cold drink, but it didn’t look like anything was open.

I sat down on the porch in the shade, settling for sipping hot water from my dwindling supply, and the next thing I knew, a pickup truck pulled up. The driver said, "I saw you looking around. You all right? Is there something you need? "

A picture of a road in Albert, Kansas depicting a red building with a covered front porch on the left hand side of the road.

This is where I sat down in the heat in Albert, Kansas.

"I was just hoping to get a cold drink," I explained. "Want some water? Pop?" he asked. "Sure," I answered. And off he went. A few minutes later, he dropped off a bottle of water and a can of soda, both ice-cold. Thanking him, I asked if I could give him anything for it. "Just say a prayer for me, " he said, and drove off, just like that.

About an hour and a half later I made it to Great Bend, just barely, woozy from the heat and down to my last swig of water. But for the kindness of this stranger from Kansas, who knows what would have happened. I made sure to thank him with a quiet prayer that night.

All these years later, in the middle of all the ugliness of the COVID-19 pandemic, I was reminded of this experience while watching YouTube. I live in New York, and ever since COVID-19 hit my state hard, Governor Andrew Cuomo has been giving daily press conferences. I try to catch them most days, both for the up-to-date statistics on the epidemic in my home state, and for the inspirational messages he often tags on at the end. On Friday, April 24th, after reporting the latest stats, he shared a letter he had just received from a man named Dennis.

"I'm a retired farmer hunkered down in northeast Kansas with my wife, who has but one lung and occasional problems with her remaining lung," the governor read aloud. “We are in our 70s now, and frankly, I am afraid for her. Enclosed, find a solitary N95 mask left over from my farming days. It has never been used. If you could, would you please give this mask to a nurse or doctor in your city? I have kept four masks for my immediate family. Please keep on doing what you do so well, which is to lead.”

I have no better words to describe how hearing this made me feel than those offered by Governor Cuomo: “How beautiful is that. How selfless is that… It is that generosity of spirit that for me, makes up for all the ugliness you see.”

Dennis, thank you for reminding me of this generosity of spirit. Once again, I find myself helped through a challenge by a stranger from Kansas. Once again, I find myself saying a quiet prayer.

I am also reminded that this is a time of increased stress for all of us, and it’s important that we take care of ourselves and our family, friends, and community. At NIMH, we’re working to help support such efforts by providing resources to help people cope, and NIMH-supported researchers across the country are also hard at work conducting research on the mental health impact of COVID-19.

We are all in this together and can get through this difficult time by showing support, kindness, and generosity toward family, friends, and strangers alike.

Original Article

Science News » Emergency Drug Overdose Visits Associated with Increased Risk for Later Suicide

A new data analysis funded by the National Institutes of Health finds patients who visited the emergency department for an opioid overdose are 100 times more likely to die by drug overdose in the year after being discharged and 18 times more likely to die by suicide relative to the general population. Additionally, in the year after emergency department discharge, patients who visited for a sedative/hypnotic overdose had overdose death rates 24 times higher, and suicide rates 9 times higher, than the general population. The findings, published in the American Journal of Preventive Medicine, highlight the need for interventions that reduce suicide and overdose risk that can be implemented when patients come to the emergency department.

“We knew that nonfatal opioid and sedative/hypnotic drug overdoses were a major cause of disease. What these new findings show is that overdose patients also face an exceptionally high risk of subsequent death—not just from an unintentional overdose, but also from suicide, non-suicide accidents, and natural causes,” said Sidra Goldman-Mellor, Ph.D., lead study author and assistant professor of public health at the University of California, Merced.

Drug-related mortality is an ongoing public health problem. Deaths by drug overdose increased 225% between 1999 and 2015, with prescription drugs and heroin overdose accounting for the majority of these deaths. Although previous studies have detailed trends in emergency department visits related to opioid and sedative/hypnotic drug overdose, less is known about the risk of death in the year following emergency care for a drug overdose.

“We have tracked and reported patient survival for health concerns such as cancers and heart surgery for decades,” said paper co-author Michael Schoenbaum, Ph.D., a senior advisor for mental health services, epidemiology, and economics at the National Institute of Mental Health (NIMH), part of the NIH. “We improve what we measure and should be doing the same type of tracking for people with overdose or suicide risk to inform our prevention and treatment programs.”

To learn more about the risks for death that follow a nonfatal opioid overdose, a research team led by Dr. Goldman-Mellor examined discharge data for all visits to emergency departments in California between 2009 and 2011. These data were matched with death records from the California Department of Public Health, which provided information about the date and cause of death for all individuals who died between 2009-2012.

The researchers focused on patients who visited the emergency department for an opioid overdose (e.g., heroin, methadone) or for a sedative/hypnotic drug overdose (e.g., barbiturate, benzodiazepine) at least once during the 2009-2011 study period.

The data showed that for those who had visited for sedative/hypnotic drug overdose, the death rate in the following year was 18,080 per 100,000; for those who had visited for an opioid overdose, the death rate in the following year was 10,620 per 100,00 patients. The death rates for these groups were significantly higher than the death rate observed in a demographically matched group of Californians (3,236 per 100,000 people).

Eighty-eight percent of the unintentional deaths among patients who had visited for opioid overdose were caused by an unintentional overdose (1,863 per 100,000)—a rate 100 times higher than that of the general population. The suicide rate for this group (319 per 100,000 patients), which included some deaths by intentional drug overdose, was 18 times higher than that of the general population.

Sixty percent of unintentional deaths among patients who had visited for sedative/hypnotic overdose were caused by an unintentional drug overdose (342 per 100,00 patients)—a rate 24 times higher than that of the general population. Among those who had previously experienced a sedative/hypnotic drug overdose, the rate of death by suicide (174 per 100,000 patients) was almost 9 times higher than the general population.

“There are already promising emergency department-based interventions that could reduce overdose and other mortality risks, such as suicide, among these patients, but such interventions need to be much more widely implemented,” said Dr. Goldman-Mellor. “Moreover, those interventions should target not just patients overdosing on opioids, but also those overdosing on sedative/hypnotic drugs, since their mortality risks were also very high.”

Dr. Goldman-Mellor indicated that although this study provides important information about the outcomes of individuals presenting to emergency departments after an overdose, the findings should be replicated in other parts of the U.S. using more recent data, as patterns of opioid and sedative/hypnotic use (and related mortality) have changed substantially over time.

Reference

Goldman-Mellor, S., Olfson, M., Lidon-Moyano, C., & Schoenbaum, M. (2020). Mortality following nonfatal opioid and sedative/hypnotic drug overdose. American Journal of Preventive Medicine.

Grant

MH113108

About the National Institute of Mental Health (NIMH): The mission of the NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure. For more information, visit the NIMH website.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit the NIH website.

NIH…Turning Discovery Into Health®

Original Article