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The National Institute of Mental Health (NIMH) is part of the federal government of the United States and the largest research organization in the world specializing in mental illness. It is one of the 27 component organizations of the National Institutes of Health (NIH), which is in turn part of the U.S. Department of Health and Human Services. It was formally established in 1949 and research is conducted at a central campus in Bethesda, Maryland, as well as being funded throughout the United States. The stated mission of NIMH is to reduce the burden of mental illness and behavioral disorders through ('biomedical') research on mind, brain and behavior. NIMH is particularly known for studies of genetics, neuroscience and clinical trials of psychiatric medication.
Research agenda[edit | edit source]
NIMH has identified four overarching Strategic Objectives for itself: Promote Discovery in the Brain and Behavioral Sciences to Fuel Research on the Causes of Mental Disorders; Chart Mental Illness Trajectories to Determine When, Where and How to Intervene; Develop New and Better Interventions that Incorporate the Diverse Needs and Circumstances of People with Mental Illnesses; Strengthen the Public Health Impact of NIMH-Supported Research. The current director of NIMH, Tom Insel, is a psychiatrist who for the prior 20 years had worked in neuroscience lab research investigating the molecular and cellular basis for complex behavior in mammals; he has said that during that time he did not read psychiatric journals or keep up in any way with research on mental illnesses, but in 2002 took up the NIMH post in order to try to help very ill people and to apply tools for studying the brain in order to understand schizophrenia, bipolar disorder, mood and anxiety disorders as brain illnesses.
NIMH's agenda has been repeatedly criticised by the American Psychological Association and others for focusing too much on the brain and genetics while allegedly giving very little attention to developments in the behavioral and social sciences, although the latter are said to be essential for understanding the cognitive, affective, motivational, and social processes that go awry within mental disorders. Psychiatrist E Fuller Torrey and his Treatment Advocacy Center, on the other hand, have criticized NIMH for failing to conduct enough research directly related to the most serious mental illnesses, and for conducting studies on behavioral and social processes such as animal cognition and adolescent relationships. The NIMH director responded claiming that NIMH spends at least 60 percent of its research budget on serious mental illnesses, and that basic behavioral and neurobiological research is vital.
The Consumer/Survivor Movement organization MindFreedom International has accused NIMH of focusing too much on basic brain research that won't help in the immediate future if at all, and of only seeking new drugs rather than other kinds of assistance and therapy. A clinical psychologist has accused NIMH of allowing itself to be used as a promotional tool by the pharmaceutical industry, with a revolving door of employment between NIMH and pharmaceutical companies.
Several psychiatrists funded by NIMH have recently been the focus of congressional investigations into unreported financial links with pharmaceutical companies. NIH's procedures for monitoring conflict of interest have been described as "lax" and that NIH "currently has no ability to monitor or prevent such abuses".
History of NIMH[edit | edit source]
Mental health had traditionally been a state responsibility, but after World War II there was increasing lobbying for a federal (national) initiative. Attempts to create a National Neuropsychiatric Institute failed. Robert H. Felix, then head of the Division of Mental Hygiene, orchestrated a movement to include mental health policy as an integral part of federal biomedical policy. Congressional subcommittees were held and the National Mental Health Act was signed into law in 1946. This aimed to support the research, prevention and treatment of psychiatric illness, and called for the establishment of a National Advisory Mental Health Council (NAMHC) and a National Institute of Mental Health. On April 15, 1949, the NIMH was formally established, with Felix as director. Funding for the NIMH grew slowly and then, from the mid-1950s, dramatically. The institute took on a highly influential role in shaping policy, research and communicating with the public, legitimizing the importance of new advances in biomedical science, psychiatric and psychological services, and community-based mental health policies.
In 1955 the Mental Health Study Act called for "an objective, thorough, nationwide analysis and reevaluation of the human and economic problems of mental health." The resulting Joint Commission on Mental Illness and Health prepared a report, "Action for Mental Health", resulting in the establishment of a cabinet-level interagency committee to examine the recommendations and determine an appropriate federal response.
In 1963, Congress passed the Mental Retardation Facilities and Community Mental Health Centers Construction Act, beginning a new era in Federal support for mental health services. NIMH assumed responsibility for monitoring the Nation's community mental health centers (CMHC) programs.
During the mid-1960s, NIMH launched a campaign on special mental health problems. Part of this was a response to President Lyndon Johnson's pledge to apply scientific research to social problems. The Institute established centers for research on schizophrenia, child and family mental health, suicide, as well as crime and delinquency, minority group mental health problems, urban problems, and later, rape, aging, and technical assistance to victims of natural disasters.
Alcohol abuse and alcoholism did not receive full recognition as a major public health problem until the mid-1960s, when the National Center for Prevention and Control of Alcoholism was established as part of NIMH; a research program on drug abuse was inaugurated within NIMH with the establishment of the Center for Studies of Narcotic and Drug Abuse.
In 1967, NIMH separated from NIH and was given Bureau status within PHS. However, NIMH's intramural research program, which conducted studies in the NIH Clinical Center and other NIH facilities, remained at NIH under an agreement for joint administration between NIH and NIMH. DHEW Secretary John W. Gardner transferred St. Elizabeths Hospital, the Federal Government's only civilian psychiatric hospital, to NIMH.
In 1968, NIMH became a component of PHS's Health Services and Mental Health Administration (HSMHA).
In 1970 the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act (P.L. 91-616) established the National Institute of Alcohol Abuse and Alcoholism within NIMH.
In 1972, The Drug Abuse Office and Treatment Act established a National Institute on Drug Abuse within NIMH.
In 1973, NIMH went through a series of organizational moves. The Institute temporarily rejoined NIH on July 1 with the abolishment of HSMHA. Then, the DHEW secretary administratively established the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) – composed of the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, and NIMH – as the successor organization to HSMHA. ADAMHA was officially established in 1974.
The President's Commission on Mental Health in 1977 reviewed the mental health needs of the nation and to make recommendations to the President as to how best meet these needs in 1978.
In 1980 The Epidemiologic Catchment Area (ECA) study, an unprecedented research effort that entailed interviews with a nationally representative sample of 20,000 Americans was launched. The field interviews and first wave analyses were completed in 1985. Data from the ECA provided a picture of rates of mental and addictive disorders and services usage.
The Mental Health Systems Act – based on recommendations of the President's Commission on Mental Health and designed to provide improved services for persons with mental disorders – was passed. NIMH participated in development of the National Plan for the Chronically Mentally Ill, a sweeping effort to improve services and fine-tune various Federal entitlement programs for those with severe, persistent mental disorders.
In 1987, Administrative control of St. Elizabeths Hospital is transferred from the NIMH to the District of Columbia. NIMH retained research facilities on the grounds of the hospital. The NIMH Neuroscience Center and the NIMH Neuropsychiatric Research Hospital, located on the grounds of St. Elizabeths Hospital, were dedicated in 1989.
In 1992, Congress passed the ADAMHA Reorganization Act, abolishing ADAMHA. The research components of NIAAA, NIDA and NIMH rejoined NIH, while the services components of each institute became part of a new PHS agency, the Substance Abuse and Mental Health Services Administration (SAMHSA). The return to NIH and the loss of services functions to SAMHSA necessitated a realignment of the NIMH extramural program administrative organization. New offices were created for research on Prevention, Special Populations, Rural Mental Health and AIDS.
In 1993, NIMH established the Silvio O. Conte Centers program to provide a unifying research framework for collaborations to pursue newly formed hypotheses of brain-behavior relationships in mental illness through innovative research designs and state-of-the-art technologies.
NIMH established the Human Brain Project to develop, through cutting-edge imaging, computer, and network technologies, a comprehensive neuroscience database accessible via an international computer network.
In 1994 The House Appropriations Committee mandated that the director of NIH conduct a review of the role, size, and cost of all NIH intramural research programs (IRP). NIMH and the National Advisory Mental Health Council (NAMHC) initiated a major study of the NIMH Intramural Research Program. The planning committee recommended continued investment in the IRP and recommended specific administrative changes; many of these were implemented upon release of the committee's final report; other changes — for example, the establishment of a major new program on Mood and Anxiety Disorders — have been introduced in the years since.
In 1996 NIMH, with the NAMHC, initiated systematic reviews of a number of areas of its research portfolio, including the genetics of mental disorders; epidemiology and services for child and adolescent populations; prevention research; clinical treatment and services research. At the request of the National Institute for Mental Health director, the NAMH Council established programmatic groups in each of these areas. NIMH (National Institute of Mental Health) continued to implement recommendations issued by these Workgroups.
Childhood Mental Disorders Research Prioritization – NIMH increased the priority placed on research on childhood mental disorders and clinical neuroscience and initiated efforts to expand research in these areas.
Implementation of Human Subjects Protection in Clinical Research - The National Institute for Mental Health expanded its efforts to safeguard and improve the protections of human subjects who participate in clinical mental health research.
In 1996, NIMH initiated planning for integration of the Institute's peer review system for neuroscience, behavioral and social science and AIDS research applications into the overall NIH peer review system.
In 1997, NIMH realigned its extramural organizational structure to capitalize on new technologies and approaches to both basic and clinical science, as well as changes that had occurred in health care delivery systems, while retaining the Institute's focus on mental illness. The new extramural organization resulted in three research divisions: Basic and Clinical Neuroscience Research; Services and Intervention Research; and Mental Disorders, Behavioral Research and AIDS.
Between 1997 and 1999 NIMH refocused career development resources on early careers and added new mechanisms for clinical research.
In 1999 The NIMH Neuroscience Center/Neuropsychiatric Research Hospital was relocated from St. Elizabeths Hospital in Washington, D.C. to the NIH Campus in Bethesda, Maryland, in response to the recommendations of the 1996 review of the NIMH (National Institute of Mental Health) Intramural Research Program by the IRP Planning Committee.
The first White House Conference on Mental Health, held June 7, in Washington, D.C., brought together national leaders, mental health scientific and clinical personnel, patients, and consumers to discuss needs and opportunities. The National Institute on Mental Health developed materials and helped organize the conference.
U.S. Surgeon General David Satcher released The Surgeon General's Call To Action To Prevent Suicide, in July, and the first Surgeon General's Report on Mental Health, in December. NIMH, along with other Federal agencies, collaborated in the preparation of both of these landmark reports.
In the late 1990s, NIMH instituted a variety of approaches relating to increasing public participation in its priority setting and strategic planning processes.
NIMH expanded and revitalized its public education and prevention information dissemination programs.
NIMH included members of the public on its scientific review committees reviewing grant applications in the clinical and services research areas.
NIMH launched a five year communications initiative in March 2000 called the Constituency Outreach and Education Program, enlisting nationwide partnerships with state organizations to disseminate science-based mental health information to the public and health professionals, and increase access to effective treatments.
NIMH organized the "14th International Conference on Challenges for the 21st Century: Mental Health Services Research", held in Washington, D.C., July 2000, to address how to meet mental health service needs nationwide most effectively, reduce health disparities, and provide equitable treatments in an era of managed care.
NIMH launched several long-term, large-scale, multi-site, community based clinical studies to determine the effectiveness of treatment for bipolar disorder (also called manic-depressive illness); depression in adolescents; antipsychotic medications in the treatment of schizophrenia, and management of psychotic symptoms and behavioral problems associated with Alzheimer's disease; and subsequent treatment alternatives to relieve depression.
The Surgeon General released a Report on Children's Mental Health indicating that the nation is facing a public crisis in the mental health of children and adolescents. The National Action Agenda outlines goals and strategies to improve services for children and adolescents with mental and emotional disorders. NIMH along with other Federal agencies collaborated in the preparation of this report.
Researchers associated with NIMH[edit | edit source]
In 1970, Dr. Julius Axelrod, a NIMH researcher, won the Nobel Prize in Physiology or Medicine for research into the chemistry of nerve transmission for "discoveries concerning the humoral transmitters in the nerve terminals and the mechanisms for their storage, release and inactivation." He found an enzyme that terminated the action of the nerve transmitter, noradrenaline in the synapse and which also served as a critical target of many antidepressant drugs.
Dr. Louis Sokoloff, a NIMH researcher, received the Albert Łasker Award in Clinical Medical Research for developing a new method of measuring brain function that contributed to basic understanding and diagnosis of brain diseases. Dr. Roger Sperry, a longtime NIMH research grantee, received the Nobel Prize in Medicine or Physiology for discoveries regarding the functional specialization of the cerebral hemispheres, or the "left" and "right" brain.
In 1983, NIMH-funded investigator Fernando Nottebohm discovered the formation of new neurons in brains of adult song-birds; this evidence of "neurogenesis" opened a clinically promising new line of research in brain science.
Dr. Eric Kandel and Dr. Paul Greengard, each of whom have received NIMH support for more than three decades, shared the Nobel Prize in Physiology or Medicine with Sweden's Dr. Arvid Carlsson. Dr. Kandel received the prize for his elucidating research on the functional modification of synapses in the brain. Initially using the sea slug as an experimental model but later working with mice, he established that the formation of memories is a consequence of short and long-term changes in the biochemistry of nerve cells. Dr. Greengard was recognized for his discovery that dopamine and a number of other transmitters can alter the functional state of neuronal proteins, and also that such changes could be reversed by subsequent environmental signals.
Nancy Andreasen, M.D., Ph.D., a psychiatrist and long-time NIMH grantee, wins National Medal of Science for her groundbreaking work in schizophrenia and for joining behavioral science with neuroscience and neuroimaging. The Presidential Award is one of the nation's highest awards in science.
In 2006, Pearson Sunderland III, chief of the geriatric psychiatry of NIMH, was sentenced to two years of supervised probation for accepting about $285,000 from Pfizer Inc. while working on drug studies at NIMH and with NIMH's awareness of the conflict of interest. Part of a wider scandal, more than 40 NIMH scientists were thought to have engaged in outside, fee-based relationships with private companies and most were disciplined internally or retired.
In 2008, psychiatrist Alan Schatzberg stepped down as principal investigator on his grant from NIMH after it came to light that the study was on a drug being developed by Corcept Therapeutics, a company Schatzberg had himself set up and in which he had several millions of dollars’ worth of stock.
NIMH directors[edit | edit source]
|Robert H. Felix||1949||1964|
|Stanley F. Yolles||1964||1970|
|Bertram S. Brown||1970||1977|
|Shervert H. Frazier||1984||1986|
|Lewis L. Judd||1988||1992|
|Frederick K. Goodwin||1992||1994|
|Rex William Cowdry (Acting)||1994||1996|
|Steven E. Hyman||1996||2001|
|Richard K. Nakamura (Acting)||2001||2002|
|Thomas R. Insel||2002||Present|
See also[edit | edit source]
References[edit | edit source]
- Grob, GN. (1996) Creation of the National Institute of Mental Health. Public Health Reports. 1996 Jul–Aug; 111(4): 378–381.
Further reading[edit | edit source]
- Psychology and the National Institute of Mental Health: A Historical Analysis of Science, Practice, and Policy, Edited by Wade E. Pickren, PhD and Stanley F. Schneider, PhD, American Psychological Association, 2004, ISBN 1-59147-164-8
[edit | edit source]
- Official website
- National Institutes of Health
- U.S. Department of Health and Human Services
- Substance Abuse and Mental Health Services Administration (SAMSHA)
- Mental Health: A Report from the Surgeon General
- Culture, Race and Ethnicity: A Supplement to the Surgeon General's Report
- World Health Organization: Global Burden of Disease Study
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