The National Institute of Mental Health (NIMH) continues to underfund scientific research into serious mental illnesses, defined as schizophrenia, bipolar disorder, autism, severe forms of depression, panic disorder, and obsessive-compulsive disorder, according to a report released by the Treatment Advocacy Center and the Public Citizen Health Research Group. The report, which analyzes NIMH research awards for fiscal year 2002, shows that 28.5 percent of award funds allocated by NIMH went to research on these disorders, even though the disorders account for 58 percent of total direct costs of all mental illnesses.
Between 1997 and 2002, the proportion of NIMH research awards for all aspects of serious mental illnesses decreased by 11 percent—from 32.1 percent to 28.5 percent, according to the report. For clinically relevant aspects of serious mental illnesses—that is, for research that is reasonably likely to improve the treatment and quality of life of affected individuals—awards decreased by 22 percent, from 7.4 percent in 1997 to 5.8 percent in 2002. The report points out that these decreases occurred during a period in which the NIMH budget doubled—from $661 million in 1997 to $1.3 billion in 2002.
The report is the third in a series analyzing NIMH's research portfolio since 1997 and identifying rejected proposals. The first report, published in 1999 by the National Alliance for the Mentally Ill (NAMI) and the NAMI Research Institute—A Mission Forgotten: The Failure of the National Institute of Mental Health To Do Sufficient Research on Severe Mental Illness—found that only about a third of 1997 awards went to research on severe mental disorders and recommended that two-thirds of NIMH annual resources should be allocated to research on serious mental illnesses. The second report in the series, published in 2000 by the Treatment Advocacy Center, found no improvement in the percentage of allocations for research on severe mental illnesses.
In a statement released along with the current report, E. Fuller Torrey, M.D., the report's lead author and president of the Treatment Advocacy Center's board, said, "By not funding research on serious mental illnesses, NIMH isn't simply hurting scientists, it's blocking research that could improve the lives of millions of the most vulnerable Americans. NIMH's refusal to do an adequate amount of research on serious mental illnesses is a federal disgrace and a personal tragedy for individuals affected with these diseases."
Research projects that the institute chose to fund may be necessary and valid, the report's authors said, but they should not come at the expense of NIMH's commitment to studying serious mental illnesses. Many other federal institutions, ranging from the National Science Foundation to the U.S. Department of Transportation, should be funding research currently paid for by NIMH. For example, the report criticizes NIMH for funding research on depression among women with breast cancer, calling on the National Cancer Institute to support such studies.
According to the report, NIMH has rejected many valid research proposals and funded others that appear to have no relationship to serious mental illnesses. The projects that were rejected would have cost approximately the same amount as those that were funded. For example, in 2002 NIMH rejected funding for a study of bipolar disorder among children, for research on measuring lithium levels in the brain, and for a study of alternative means of supporting patients released from psychiatric hospitals. Instead it funded research to ascertain how people in Papua New Guinea "think about their own relationships in the real world," to examine social communication among electric fish, and to determine how people in Czechoslovakia cope with social change, the report noted.
The report makes several recommendations, including holding Congressional hearings to establish a minimum percentage of the NIMH budget that must be spent on research into serious mental illness and directing the General Accounting Office to evaluate the NIMH research portfolio.
Other advocacy groups were quick to condemn the report. For example, the National Mental Health Association called it "shortsighted and dangerous … bad science and bad public health" and accused it of "slandering NIMH's broad research agenda," criticizing legitimate research on disorders affecting millions of people, and "ridiculing" efforts to improve the cultural competence of mental health interventions.
A Federal Failure in Psychiatric Research: Continuing NIMH Negligence in Funding Sufficient Research on Serious Mental Illnesses can be downloaded from the Treatment Advocacy Web site at www.psychlaws.org.
Howard H. Goldman Appointed Editor of Psychiatric Services,Will Serve as Editor Designate
At its December meeting, the board of trustees of the American Psychiatric Association approved the appointment of Howard H. Goldman, M.D., Ph.D., as editor designate of Psychiatric Services. Dr. Goldman has been associated with the journal for many years and was a member of the Psychiatric Services editorial board from 1993-2001. He currently serves as a peer reviewer and as contributing editor for the State Mental Health Policy column.
Since the late 1970s Dr. Goldman has been an active policy consultant and has been involved in numerous editorial activities. He served on the Task Force on Health Care Reform during the Clinton Administration and advised the President's New Freedom Commission on Mental Health under the current Administration. He has been elected to membership of the National Academy of Social Insurance and the Institute of Medicine. Dr. Goldman has been on the editorial boards of several journals in addition to Psychiatric Services, including the American Journal of Psychiatry and Health Affairs. He is the editor of five editions of Review of General Psychiatry, a text for medical students. He served as the senior scientific editor of Mental Health: A Report of the Surgeon General, for which he received the Surgeon General's Medallion.
John A. Talbott, M.D., editor of the journal since 1981, and Dr. Goldman will share editorial responsibilities for the next several months to ensure a smooth transition.
CMS decision on DSM codes: The Centers for Medicare and Medicaid Services (CMS), which administers the Medicare and Medicaid programs, has announced that it will continue to allow psychiatrists and other clinicians to use the criteria in DSM-IV to determine the appropriate codes for the mental health services that they provide to the programs' beneficiaries. The decision allays concerns by psychiatrists and other mental health professionals that CMS would mandate exclusive use of codes from the International Classification of Diseases, Ninth Revision-Clinical Modification (ICD-9-CM). Since 1980, when the American Psychiatric Association published DSM-III, the federal government has allowed clinicians to use the diagnostic manual to "cross-walk" to the ICD system.A chief concern was that the ICD-9-CM uses DSM-II definitions from 1968. CMS has posted information for practitioners on the Web at http://questions.cms.hhs.gov. Click on FAQs and search on DSM-IV.
Improved Web site of National Guideline Clearinghouse: The National Guideline Clearinghouse (NGC), a public resource for evidence-based practice guidelines sponsored by the Agency for Healthcare Research and Quality in partnership with the American Medical Association and the American Association of Health Plans, contains 1,159 detailed summaries of guidelines from more that 200 medical and psychiatric organizations, academic institutions, and government agencies. New features include enhanced summary content, such as descriptions of methods used to formulate recommendations and schemes for rating the strength of recommendations. The site now offers summaries that are downloadable to personal digital assistants. An enhanced search function permits users to pinpoint the most relevant guidelines by combining an array of search categories, including keyword; condition; treatment; guideline category; organization or type of organization; intended users; clinical specialty; methods used to assess the strength of the guidelines, analyze the evidence, and formulate the recommendations; age and sex of the target population; and date of publication. More information is available at www.guideline.gov.
Three educational booklets for Spanish-speaking patients: The National Institute of Mental Health (NIMH) has released Spanish-language versions of three educational publications for Spanish-speaking patients who are experiencing symptoms of manic-depression, depression, or social phobia. In Una Historia Personal Obre el Trastorno Bipolar (Enfermedad Maníaco-Depresiva), a patient tells the story of how he lost control of his life because of an illness he knew little about and how he got help. The 20-page booklet includes checklists for identifying symptoms of mania and of depression, basic facts about manic-depression, advice about how to find a physician, and information on treatments and resources. The booklets on depression, Historias Personales Sobre la Depresión, and social phobia, Una Enfermedad Real: Fobia Social, have similar formats, with patients' stories told in their own words. Single copies can be ordered online and bulk orders by telephone or fax. More information is available on the NIMH Web site at http://infocenter. nimh.nih.gov/index.cfm.
AWHONN tool for detection of domestic violence: What constitutes domestic violence, and how prevalent is it? What are the signs and symptoms of abuse? What can health care providers do to help battered women? What are the implications of the current mandatory reporting laws? These are among the questions addressed in the second edition of "Universal Screening for Domestic Violence," a presentation package of materials developed by the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) to help professionals educate staff about identifying, treating, and assisting victims of domestic violence. The package is on CD-ROM and includes a slide presentation, an abuse screening tool (in English and Spanish), a danger assessment tool, and a list of resources. The package can be ordered online from AWHONN's Web site at www. awhonn.org. The cost is $30 for AWHONN members and $40 for nonmembers.