Advocacy Archive
Behavioral Science at NIMH Criticized
Dear Colleague:
You may be aware that the National Institute of Mental Health (NIMH) has become the target of an attack by an advocacy group comprised of families living with mental illness. The National Alliance for the Mentally Ill has issued a report claiming that NIMH funding for behavioral science, AIDS and basic neuroscience comes at the expense of research on schizophrenia. They also have taken their case to the press, resulting in a sensationalized front page headline in the Dec. 6 USA Today: Mental health research ‘fails.' This attack comes as a shock to NIMH and to those of us who have worked with advocates for people with mental illness and their families. It is divisive, pits areas of science against one another, pits one disease against others, and jeopardizes NIMH's public and political standing. Following is a letter that I have sent to NIMH Director Steven Hyman stating our concern over this attack, and outlining the strong support that Congress has expressed for NIMH's behavioral science programs.
Best, Alan
December 7, 1999
Steven E. Hyman, Director
National Institute of Mental Health
6001 Executive Blvd.
Bethesda, MD 20892
Dear Dr. Hyman:
I write to express the dismay of the American Psychological Society (APS) at the recent report prepared by the National Alliance for the Mentally Ill (NAMI) on the research portfolio of the National Institute of Mental Health (NIMH). We believe the report's authors misstate the mission of NIMH. The report's narrow perspective fails to credit the Institute's strong record of accomplishment in researching the full range of mental health disorders afflicting American families.
A portion of NAMI's criticism focuses on NIMH's behavioral research portfolio (although the report also unjustly criticizes NIMH for its work on AIDS and neuroscience). Under your leadership, NIMH has broadened its portfolio to include new and cutting edge research on a wide range of mental health issues. Naturally, the Institute continues to devote substantial resources on research regarding schizophrenia and other serious mental illnesses. But you also have focused attention on such important subjects as violence, behavior disorders in children and adolescents, chronic mood disorders, anxiety disorders, functional problems associated with brain damage, the intersection of behavior and neuroscience, physical and mental health, and various aspects of public health, to name just a few.
Each of these research areas is well within the core mission of NIMH, and NIMH's efforts in these areas have been endorsed by Congress. The NAMI report's authors are short-sighted in failing to recognize that a solid portfolio of basic and applied behavioral research is an indispensable component of NIMH's efforts to serve those with schizophrenia and other mental illnesses. To give just one concrete example, patient adherence to drug regimens is an enormously important issue for people with schizophrenia and other mental illnesses. Fifty percent of patients with schizophrenia do not take their medication properly. Basic behavioral research holds the key to addressing this problem.
Apart from what NAMI or APS believes the NIMH research portfolio should be, a key question is what does Congress believe the NIMH research portfolio should be? I have attached a compilation of some of the authoritative directions Congress has provided to NIMH about behavioral research in appropriations and authorizations reports going back several years. These statements include broad policy directives and specific research initiatives. They represent Congress' effort to shape and endorse an NIMH agenda of wonderfully wide breadth. We believe that it is the breadth of the agency's mission, as well as the excellence with which you have implemented it, that accounts for the strong funding support NIMH has received from Congress.
Please know that APS endorses your efforts, and we urge you to stand firm in the face of these unwarranted and divisive attacks on NIMH's outstanding behavioral science research portfolio.
Sincerely,
Alan G. Kraut
Executive Director
Selected Congressional Statements on Behavioral Science at NIMH
NIMH Mission in Behavioral Science
When NIMH was transferred to NIH in 1992, Congress established NIMH's mission as follows: "The general purpose of the National Institute of Mental Health... is the conduct and support of biomedical and behavioral research, health services research, research training, and health information dissemination with respect to the cause, diagnosis, treatment, control and prevention of mental illness." Further, Congress expressly authorized that NIMH's research program "shall be designed to further treatment and prevention of mental illness, the promotion of mental health, and the study of the psychological, social and legal factors that influence behavior."
In the explanatory language accompanying this legislation, the House and Senate conferees issued the following statement: "The conferees do not intend the reorganization [of the Alcohol, Drug Abuse and Mental Health Administration] to diminish the important behavioral science portfolios of the three former ADAMHA institutes. Indeed, the conferees expect that the transfer of these three institutes will bring to all of the NIH institutes an increased appreciation for and emphasis on behavioral science and health services research. The conferees reiterate their strong support for psychological, behavioral and social research in the understanding of mental, addictive and physical disorders.
Clinical Experiences and Public Health
FY 00 Senate: The Committee notes that NIMH has strengthened its infrastructure to manage more optimally both basic and applied research on behavioral processes. The Committee is pleased to learn that the National Advisory Mental Health Council has now established a subgroup to improve connections between basic behavioral research and clinical and applied issues. The Committee requests that the Institute be prepared to report on specific research and training recommendations during next year's hearing. The Committee commends NIMH for its initiative to increase the connections between academic departments of psychology and schools of public health with the goal of more research with a joint perspective in public health and behavioral research.
FY99 Senate: The Committee notes the efforts of the NIMH to advance behavioral science and to train more behavioral researchers. The Committee encourages the NIMH to continue to make behavioral science more relevant to the public health and to create linkages to advances in the brain sciences.
FY 98 House: The Committee is aware that NIMH is undergoing a reorganization to improve connections between basic and clinical research and links between disciplines, and to reflect promising new directions in mental health research. The Committee applauds this approach and views it as consistent with past Committee efforts to encourage NIMH to implement its national advisory council's report on behavioral research and to encourage new mechanisms to develop basic behavioral researchers who are sensitive both to clinical and biological issues.
FY 98 Senate: The Committee is aware that NIMH is undergoing a reorganization to improve connections between basic and clinical research and links between disciplines, and to reflect promising new directions in mental health research. The Committee applauds this approach. The Committee looks forward to the NIMH Director's update of these issues to the Committee.
FY 97 Senate: The Committee appreciates that a great deal of basic behavioral research that can be brought to bear on the most serious of mental disorders and encourages NIMH to develop mechanisms to build a generation of basic behavioral researchers who are sensitive to clinical issues. For example, the Committee encourages the Institute to give consideration to allowing nonclinical graduate students in psychology and other behavioral sciences to have research experiences on NIMH grants in medical settings. Similarly, for clinical psychology programs, particularly those housed outside of medical schools, the Committee encourages NIMH to provide student support for research in settings in which severe mental disorders are the focus.
FY 97 House: The Committee understands that much basic behavioral research can be brought to bear on the most serious mental disorders and encourages NIMH to develop mechanisms to build a generation of basic behavioral researchers who are sensitive to clinical issues.
Training
FY 98 Senate: Young investigators: The Committee is pleased that three institutes, NIMH, NIDA, and NIA, have established small grant mechanisms for young investigators in behavioral science research. The Committee continues to encourage other National Institutes to develop mechanisms similar to these behavioral science track award for rapid transition (B/START) programs.
FY 96 Senate: (T)o meet the need to train mental disorder prevention researchers, the Committee supports NIMH in expanding funding for the B-START program, both for those at the beginning stages of their career and for career transitions to behavioral science research.
FY 96 House: (T)o meet the need to train mental disorder prevention researchers, the Committee encourages NIMH to maintain its support for the B-START program, both for those at the beginning stages of their career and for career transitions to behavioral science research.
FY 95 Senate: Young behavioral science investigators: The Committee notes that NIMH has initiated the B/START program to increase the supply of young investigators in behavioral science. The Committee has in previous years expressed concern about the alarming decline in the number of new investigators in psychology and other behavioral sciences. The Committee understands that the current level of funding for B/START cannot support the overwhelming number of otherwise eligible applications NIMH has received for the program. Therefore, the Committee encourages NIMH to increase funding in FY 1995 for B/START.
Behavioral Science Research Plans
FY 99 Senate: Basic Behavioral Research. - For several years, the Committee has urged NIMH to strengthen its portfolio in basic behavioral research. The Committee continues to see basic behavioral research as one of NIMH's core responsibilities and urges the Institute to establish, in consultation with leading experts from the field, specific research and training initiatives to develop the base of theoretical knowledge on behavioral aspects of mental health and mental illness and to improve the connections between basic and clinical research.
FY 97 Senate: The Committee is pleased that NIMH supported the development of a behavioral science research plan aimed at reducing depression, schizophrenia, and other severe mood and anxiety disorders. The plan, Reducing Mental Disorders: A Behavioral Science Research Plan for Psychopathology, was developed under the auspices of the human capital initiative and has been endorsed by an impressive range of scientific organizations. The Committee urges NIMH to use the plan in determining its research priorities, and requests the Institute to be prepared to report on how it intends to use this plan during the fiscal year 1998 hearings. Finally, the Committee reiterates its support for the National Advisory Mental Health Council's report, "Basic Behavioral Science Research for Mental Health: A National Investment." In particular, the Committee supports recommendations to fund more investigator-initiated behavioral research, provide new funding mechanisms for longitudinal behavioral research, and expand study sections for the best possible review of behavioral science.
FY 97 House: The Committee is pleased to learn that NIMH supported the development of a behavioral science research plan aimed at reducing depression, schizophrenia, and other severe mood and anxiety disorders. The Committee encourages NIMH to consider the plan in determining its research priorities, and looks forward to discussing the use of the plan in next year's appropriations hearings.
FY 96 Senate: The Committee is pleased to have received from the National Advisory Mental Health Council its report: "Basic Behavioral Science Research for Mental Health: A National Investment," which identifies promising research directions for the basic behavioral sciences at NIMH. Because behavioral and psychosocial factors play such a critical role in both physical and mental health and illness, the Committee believes that basic behavioral research on these factors is particularly important for the development of solutions to these costly and debilitating problems. The Committee urges NIMH to begin implementation of the recommendations contained in the report.
FY 96 House: The Committee continues its support of basic behavioral science research as recommended by the NIMH Advisory Council. In particular, NIMH is encouraged to consider the recommendation regarding increased emphasis on individual investigator grants. The Committee would like a progress report on implementing the Advisory Council recommendations before the fiscal year 1997 appropriations hearings.
FY 95 Senate: The Committee received the NIMH National Advisory Council's report on "Basic Behavioral Science Research for Mental Health" requested in last year's appropriations...and commends the Council on its comprehensive analysis of the broad range of basic behavioral research to critical to understanding mental health and metal illness. The Committee has long supported increased emphasis at NIMH on basic behavioral science and the report should serve as a blueprint for achieving such an increase. The Committee views the report in the same mold as NIMH's other national plans for schizophrenia and neuroscience research. The Committee strongly encourages NIMH to implement the report's recommendations as summarized in the executive summary and that section dealing with infrastructure issues. The Committee would like to receive by February 1, 1995, a plan from NIMH on how the Institute is achieving these recommendations, with an eye toward how the Institute is increasing its individual investigator (RO1) grants in behavioral science.
FY 95 House: The Committee commends the NIMH national advisory council for its report on basic behavioral science research. The Committee supports an increased emphasis on basic behavioral science and believes the report is an appropriate blueprint. The Committee would like to receive prior to the 1996 appropriation hearings a report on how the Institute is responding to these recommendations.
FY 94 Senate: The Committee understands that the NIMH National Advisory Council is in the midst of a major effort to develop a behavioral science research agenda. It has convened a distinguished behavioral science task force of outside experts and they are now conducting a comprehensive assessment of the basic behavioral and psychosocial research. The result should be a national plan for behavioral science research similar to other NIMH reports that have shaped the Institute's programs in schizophrenia, child and adolescent mental disorders, and neuroscience. The Committee applauds this effort and is looking forward to receiving the task force report when it is presented to the NIMH National Advisory Council. Further, the Committee requests NIMH to report back to Congress within 60 days of the final task force report with plans for implementing the recommendations of the task force.
Child Abuse and Neglect Research
FY 97 Senate: The Committee recognizes the magnitude and significance of the problem of child abuse and neglect. An excellent report done in 1993 by the National Research Council (NRC) on understanding child abuse and neglect examines the current state of research in this area and recommends a research agenda designed to address the problems and gaps that currently exist. In order to facilitate collaborative and cooperative efforts in this important area, the Committee urges NIH to convene a working group made up of representatives of its component organizations currently supporting research on child abuse and neglect. The Committee further encourages the working group to hold a conference on child abuse and neglect to assess the state-of-the-art science and make recommendations for a research agenda in this field, and include in this conference relevant outside organizations and experts in the field. The Committee requests that this working group be prepared to report on current NIH efforts in this area, the accomplishments of that research, and on plans for future coordinated efforts at the NIH at the fiscal year 1998 hearings.
FY 97 House: The Committee recognizes the magnitude and significance of the problem of child abuse and neglect. A 1993 National Research Council report entitled "Understanding Child Abuse and Neglect" examined the current state of research in this area and recommended a research agenda designed to address the problems and gaps that currently exist. In order to facilitate collaborative and cooperative efforts in this important area, the Committee encourages NIH to convene a working group of its component organizations currently supporting research on child abuse and neglect. The Committee requests that this working group be prepared to report on current NIH research efforts in this area, the accomplishments of that research, and on plans for future coordination efforts at NIH at the fiscal year 1998 hearings.
Violence Prevention
FY 00 Senate: The Committee is deeply concerned about the recent wave of school shootings across the country, and believes that NIH has an important role to play in helping policy makers understand and respond to the causes of such violent antisocial behavior. The Committee encourages NIMH as well as other institutes to increase support for behavioral research relating to violence, and to provide ways to better understand how to apply the knowledge from this research when designing effective treatment and prevention programs.
FY 99 Senate: Violence against women: The Committee encourages the NIMH to focus more attention on research into prevention, treatment, and intervention, and subsequently to pursue large-scale trials of research on violence against women, including behavioral and psychosocial factors.
FY 96 House: NIMH is encouraged to support research pertaining to behavior modification and attitude change within the general population and their role in increasing criminality and violence. This would also include the research questions involved in psychological profiling of violent, criminal, and destructive personalities.
FY 95 Senate: Violent crime has become one of the most urgent problems our Nation faces. While environmental factors play a major role in the development of violent behavior, there exists the possibility that physiological and genetic factors also play a role in the development of violent behavior.
Prevention
FY 98 House: Children and adolescents: The Committee is pleased that NIMH is placing a high priority on research to better understand childhood and adolescent mental disorders. Too little is known about the emotional development of children and adolescents, and even less is known about preventive interventions and treatments for mental disorders at these early ages. The Committee encourages NIMH to strengthen its research about all childhood mental disorders, including autism, and to establish a full range of preventive interventions and treatments based on behavioral approaches as well as medications.
FY 97 Senate: The Committee is pleased that a workgroup of NIMH Advisory Council is examining the current state of NIMH prevention research. The Committee places a high priority on prevention research, particularly with respect to mental disorders among children and adolescents. In addition, the Committee encourages NIMH to magnify its efforts to address the critical shortage of researchers in the area of prevention.
FY 97 Senate: The second decade of life: The Committee notes that the incidence of psychosocial disorders is higher among individuals in their second decade of life than in older people. Accordingly, the Committee urges NIMH to join with the NICHD, NINR, and other Institutes to support basic research on this period of the lifespan.
FY 96 House and Senate: In keeping with the Committee's interest in NIMH support for prevention research, the Committee commends NIMH for developing an implementation plan to address the recommendations of the 1994 Institute of Medicine report "reducing Risk of Mental Disorders: Frontiers for Preventive Intervention Research," and urges timely implementation of two areas of primary importance. First, to meet the need to train mental disorder prevention researchers, the Committee encourages NIMH to maintain its support for the B/START program, both for those at the beginning stages of their career and for career transitions to behavioral science research. Second, the Committee urges NIMH to take the lead among Federal research agencies in coordinating research efforts to prevent mental disorders.
FY 95 Senate: The Committee is pleased with the release of the Congressionally requested report by the Institute of Medicine on "Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research." The Committee encourages the funding of postgraduate and midcareer training of prevention researchers to fully fund existing programs and increase the number of training sites at the National Institute of Mental Health (NIMH). As part of the expenditure of these dollars, a major effort should be made to encourage the prevention research training of minorities and directs NIMH to include prevention researchers with broad mental health perspectives on its National Advisory Council. Training of midcareer scientists and postdoctoral students should occur within every specialized prevention research center. Dissemination activities through the PIRC's and other NIMH prevention research endeavors should receive higher priority than they have in the past.
FY 95 House: In keeping with the Committee's interest in NIMH support of prevention research, it encourages NIMH to give high priority to this area. The Committee looks forward to receiving the plan which is being formulated regarding prevention research. The Committee also encourages NIMH to include prevention researchers with broad mental health perspectives on its national advisory council.
FY 95 House: In keeping with the Committee's interest in NIMH support of prevention research, it encourages NIMH to give high priority to this area. The Committee looks forward to receiving the plan which is being formulated regarding prevention research. The Committee also encourages NIMH to included prevention researchers with broad mental health perspectives on its national advisory council.
Suicide Prevention
FY 00 Senate: The tragic suicide deaths of nearly 30,000 Americans each year points up a national public health emergency. Research to solve this health crisis is constrained, however, by legal and ethical considerations necessary in planning treatment studies that would involve the participation of persons who are at high risk for suicidal behavioral . Thus, the Committee looks forward to hearing from NIMH about the development of research networks fully informed of appropriate measures and protocols necessary to test treatments for persons at high risk for suicidal behavior....
FY 00 Senate: Suicide in children and adolescents: With regard to the tragic problem of suicidal behavior in children and adolescents, the Committee is pleased that NIMH is supplementing existing longitudinal studies of young people at risk, to add measures and analyses of suicidal behavior. More accurate information about risk factors for such behaviors should lead to more targeted suicide prevention trials in youth.
FY 98 Senate: Elderly suicide: The Committee is concerned that the rate of elderly suicide has increased by 9 percent between 1980 and 1992. The Committee has also learned from information provided by CDC that many older Americans who commit suicide have contacted a physician in the month before suicide. The Committee therefore requests the NIMH to study the extent of this problem and make recommendations on how to address the problem...
FY 97 Senate: Suicide and the elderly: The NIMH is to be congratulated for its research on the underlying causes of elderly suicide, especially efforts which address the impact of late life depression on suicidal behavior. With growing evidence suggesting that the suicide rate among the elderly is on the rise, the Committee is encouraged by this ongoing effort and welcomes continued activity on this area of research.
FY 94 House and Senate Conference: The conferees remain concerned about suicide, particularly among youths and are supportive of the [NIMH] suicide centers. The conferees strongly encourage the Institute to continue its commitment to basic and epidemiological research on potential causes and risk factors for suicide, as well as interventions to prevent suicide and suicidal behavior.
Eating Disorders
FY 99 Senate: The Committee urges additional funding be provided for prevention research on eating disorders.... The Committee defines prevention research as the development of psychosocial and behavioral interventions and strategies aimed at reducing the incidence of these disorders.
FY 98 Senate: The Committee encourages the Institute to provide additional funding for direction to the research for prevention of eating disorders...including research on the development of psychosocial and behavioral interventions and strategies aimed at reducing the incidence of eating disorders.
FY 95 House: The Committee continues to be concerned about the prevalence of eating disorders, which disproportionately affects women. The Committee urges NIMH to continue to expand its research on eating disorders and to improve its efforts to communicate prevention and treatment strategies to health care providers and the lay public.
FY 94 House: The Committee is encouraged by the Institute's emphasis on eating disorders and is pleased with the technical assessment conference on eating disorders held in May 1993. The Committee encourages the Institute to continue to follow up on the conference by initiating a public and professional eating disorders education campaign as directed in last year's report. The Committee expects the Institute to fully comply with the 1993 House directive by the end of fiscal year 1994.