Mental Health The Best of Times and the Worst of Times

1. Mental Health The Best of Times and the Worst of Times Thomas R. Insel, M.D. Director, NIMH

2. The Best of Times: Human Genome - Completed 4/14/03 Nucleotides: 3 billion Total Genes: 30,000 (about 1.5% of genome) Brain specific genes: 6,000 Total proteins: ???? Genes with known function: less than 1% Protein targets for current medications < 500

3. How do we get there from here ? psychiatric syndromes Cells: multiple subtle abnormalities Genes: multiple susceptibility alleles each of small effect Systems: abnormal information processing Behavior: complex functional interactions and emergent phenomena

4. Basic Research = Hope Hope is not enough!

5. Mental Health Care in America Fragmentation – federal, state, local; care in “shambles” according to the Pres. New Freedom Comm. Failure of access – phantom networks, workforce, restrictions on care Fallibility – evidence-based practices are not available, not supported, and not used Much of mental health care is no longer in the mental health care system.

6. Vision: Scientific rigor and relevance in real time NIMH research must be useful and practical for people with mental illnesses, their families, clinicians, purchasers, and policymakers

7. NIMH Effectiveness Trials:“what treatment for which person” STEP-BD: Treatment of adults with bipolar disorder 3065 enrolled, multiple treatment trials TADS: Treatment of adolescents with depression 432 enrolled, results due 2004 CATIE: Effectiveness of antipsychotic drugs 1450 enrolled, value of atypicals STAR*D: Adults with treatment resistant depression 2538 enrolled, 40 sites (20 primary care)

8. Intervention “evidence” is only one piece of the picture Family Access and Engagement Organization Structure and Climate Tx “Evidence” External Environment (stigma, financing) Provider knowledge and behavior

9. Services Research -Current Portfolio • Nearly 280 grants • FY 2002 funding = $190 million • 45% increase in applications from 2001-->2002 • Sociocultural • Research Methods • Clinical Epidemiology • Dissemination Research • Rural • Disablement & Functioning • Child & Adolescent • Primary Care • Quality of Care & Outcomes • Financing & Managed Care • Systems Research • Homelessness

10. Science to Innovative ServiceThree Examples • Psychosis: Early Detection, Intervention & Prevention(William McFarlane, Maine Medical Center) • Testing EBP and Organization Effects in Rural Appalachia(Charles Glisson, University of TN) • CTI In the Transition from Hospital to Community(Dan Herman, NY State Psychiatric Institute)

11. Getting Effective Treatments Implemented:Science to Services Initiative • A synergistic collaboration between NIH and SAMHSA to build on specific initiatives and activate new endeavors • Example: States Implementation RFA – to ready them to study barriers and facilitators of implementing Evidence Based Practices (partnered with CMHS)

12. State Implementation of EBPsNIMH-SAMHSA Partnership • 9 top scoring grants to be funded (~ 20% of all states) • Partnerships established between academic and state mental health agencies • Research questions identified to improve diffusion of EBPs in state systems • Proposals to test implementation of EBPs in practice settings submitted to NIMH • State level policy questions incorporated into NIMH services research proposals.

13. This slide originally contained a video clip from “Real Men. Real Depression”, available from http://menanddepression.nimh.nih.gov

14. Summary The promise of research has never been greater – science will yield new strategies for prevention, recovery, and even cures of mental disorders. The need for bridging science and service is urgent. We must ensure that “what we know is what we do”; that science informs practice. You can help – partners in research, advocates for consumers and families, advisors for bridging science and service.

15. National Institute of Mental Health Thomas Insel, M.D. Director, NIMH http://www.nimh.nih.gov 301-443-3673