National Institute on Mental Health Needs Stronger Prevention Focus

COMMENTARY

National Institute on Mental Health Needs Stronger Prevention Focus

By Dr. Carl C. Bell

Chief Executive Officer

Community Mental Health Council

Februay 2011

Dr. Carl Bell

My life's work has been about not only treating mental illness but preventing it.

That's why on Friday, Jan. 14, the day before the birthday of Dr. Martin Luther King Jr., I resigned from the prestigious National Institute on Mental Health's Mental Health Advisory Council. My reasoning? The NIMH spends a measly 5% of its budget on its fourth objective, which is "Strengthening the Public Health Impact of NIMH Supported Research."

Meanwhile, the agency spends 59% of its annual funds (about $1.5 billion) on objective No. 1, "Promote Discovery in the Brain and Behavioral Sciences to Fuel Research on the Causes of Mental Disorders"; 14% on objective No. 2, "Chart Mental Illness Trajectories to Determine When, Where, and How to Intervene"; and 21% on objective No. 3, "Develop New and Better Interventions That Incorporate the Diverse Needs and Circumstances of People With Mental Illnesses."

I had been appointed to the agency's mental health advisory council 4 years ago by the former secretary of Health and Human Services. In addition to the many other efforts with which I've been involved over the years on preventing mental illness, I have worked for more than 6 years on the Prevention in Action column that runs periodically on these pages. My commitment to prevention led me to conceptualize the column, and Diana Mahoney of this newspaper's New England Bureau brings it to fruition several times a year. In other words, I believe firmly that public policy, social capital, and actual capital should be directed toward preventing psychiatric problems.

My reality is simple: The purpose of science is to discover new knowledge, and without applying that knowledge, what's the point? The NIMH has used a lot of taxpayer money to learn a great deal about how to help people with mental disorders. Unfortunately, much of NIMH's research does not get used to help people as mental health professionals rarely use it. To make matters worse, robust evidence shows that there are several evidence based prevention interventions (see Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities [Washington: National Academies Press, 2009] and treatmentinterventions, which, if used, could help a ton of suffering people. However, for reasons that escape me, the NIMH seems reluctant to research how to implement these prevention and treatment innovations.

I understand that the NIMH is a mental health research institute and that the Substance Abuse and Mental Health Services Administration SAMHSA) is the implementation arm that puts innovations into practice. ( Just recently, the Centers for Disease Control has begun to pay attention to mental health.) The problem is that the SAMSHA is not supposed to do research, and our nation desperately needs research on how to implement evidence-based treatments and, more importantly (from a public health perspective), prevention interventions. Per its own objectives, NIMH is supposed to provide funding to do research on implementation. But, allocating 5% toward that objective is indefensible - and reprehensible.

The NIMH does not have a scientific clue about why most of its efficacious randomized, controlled trial prevention and treatment interventions are not being used. The NIMH does not have a clue about how to increase uptake of science that could help millions of people improve their lives and, potentially, never become mentally ill in the first place. I could not in good conscience sit in that room approving great research that would never be used. After all, it was the day before Dr. King's birthday.

I regret removing my advocacy from this body. But after 3 years, it became clear to me that my concerns were being met with platitudes, as the money had not shifted toward public health.
The cosmetic tokenism represented by NIMH's public health agenda is a poor use of our tax dollars.

-------------------------------------------------------------------------------------------

DR. BELL is chief executive officer and president of Community Mental Health Council Inc. of Chicago. He also serves as acting director of the Institute of Juvenile Research at the University of Illinois at Chicago and is director of public and community psychiatry at the university. You may call the Community Mental Health Council at 773.734.4033.