thomas r. insel, m.d. director, nimh/nih/dhhs the national institute of mental health and the and...
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Thomas R. Insel, M.D.Thomas R. Insel, M.D.Director, NIMH/NIH/DHHSDirector, NIMH/NIH/DHHS
The National Institute of Mental HealthThe National Institute of Mental Health and the and the
American Recovery and Reinvestment ActAmerican Recovery and Reinvestment Act
July 10, 2009
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NIMH MissionTo transform the understanding and treatment of mental illnesses
through basic and clinical research, paving the way for
prevention, recovery, and cure.
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Source: WHO World Health Report 2002
0 5 10 15 20 25 30 35
Mental Illness*
Injuries, including self-inflicted
Alcohol and drug use
Malignant neoplasms (cancer)
Cardiovascular disease
Respiratory disease
Musculoskeletal disease
Sense organ disease
Digestive disease
Burden of Disease (DALYs) U.S., Canada, and Western Europe 15-44 years old
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Public Health Impact:Early Mortality in Individuals with
Major Mental Illness (MMI)
0
5
10
15
20
25
30
35
Average Arizona Missouri Oklahoma RhodeIsland
Texas Utah
Ye
ars
of
Po
ten
tia
l Lif
e L
os
t
Adapted from Colton and Manderscheid, 2006, Prev Chronic Dis
• Average age at time of death : 56 years
• Increased likelihood of heart disease and suicide
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Direct and indirect components of the economic burden of serious mental disorders, excluding incarceration, homelessness, comorbid conditions and early mortality. ($ in billions) 1992 2002Health Care Expenditures $62.91 $100.12Loss of earning $76.71 $193.23Disability (SSI + SSDI) $16.41 $24.34 Totals $156.0 B $317.6 B
Matching Resources with Public Health Need
Insel, Am J Psychiatry, 2008
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Re-ThinkingRe-Thinking “ “Mental Illness”Mental Illness”
Mental disorders are brain disorders.
Mental disorders are developmental disorders.
Mental disorders result from complex genetic risk plus experiential factors.
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oF11pACC24
mF9/10
PCCMCC
PF9/46 Par40PM6
sACC25
hth bstema-ins
amg mb-vta
hc
na-vst thal
SalienceMotivation
MoodstateSelf-awareness
insight
Cognition(attention-appraisal-action)
Interoception(drive-autonomic-circadian)
Mental Disorders are Brain DisordersResponse Pathways for Depression
CBT
PF
MF
MCC
MedsPF
P
Cg25
PCC
BS
MEDS
Br Med Bul 65:193-207, 2003Arch Gen Psych 61:34-41-2004
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Source: J Giedd, NIMH
Prolonged Human Brain Development
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10 15 20 25
Age
# ofCortical
Synapses
Normal Development
Based on McGlashan and Hoffman (2000)
A Developmental Brain Model for Schizophrenia
Psychosis Threshold
Possible Paths to Schizophrenia
Intervention
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McCarthy et al., Nat Rev Genetics 2008
Mendeliandisease
Frequency of DNA variation in population
High
Intermediate
Modest
Low
Very rare Rare Uncommon Common
0.001 0.01 0.10
Complex Genetics of Mental Illness
Penetrance
22q11.216p11.11q21.115q13.3Disc-1
ANK3CACNA1C
HLACAM10
New technology for sequencingRepository of DNA from pts/controlsNeeded:Funds for supporting large scale effort
RareLarge effect
CommonSmall effect
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NIMH Strategic Plan (4 P’s)
•Strategic Objective #1: Pathophysiology
•Strategic Objective #2: Predictive medicine
•Strategic Objective #3: Preemptive and Personalized Interventions
•Strategic Objective #4: Public Health Impact – Participatory Research
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Nice roadmap but is there any gas in the car?
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American Recovery and Reinvestment Act (ARRA)- Impact of Economic Stimulus on NIH
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American Recovery and Reinvestment Act (ARRA)- Objectives
Stimulate the economy
Create and preserve jobs
Advance biomedical research
$10.4B to NIH
$366M to NIMH
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Scientific Research Approach - NIMH
Stimulate and accelerate biomedical research with existing mechanisms (33%)– Funding additional meritorious R01s, R21s and R03s that have
been peer reviewed and approved by NIMH Council
– Administrative supplements to accelerate ongoing research
Expand science with new programs (67%)– Revisions to extant programs (“Competitive supplements”)
– New ARRA NIH-wide programs
– New ARRA IC-specific programs
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NIMH ARRA Priorities• Jumpstart: the NIMH Strategic Plan (4P’s)
the NIH AIDS Res Strategic Plan
• Increase training, faculty recruitment, diversity
the Autism Research Strategic Plan
• Support beaker-ready projects w 2 year outcomes
• Process: transparent, careful, accountable
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New ARRA NIH-wide Programs Challenge Grants
Grand Opportunities (“GO” Grants)
Recruit new faculty to conduct research
Provide summer jobs for high school /
college students and teachers in science labs
AREA (R15) Grants
} Jumpstart Strategic Plans
}Create and Retain Jobs
} National effort
On average, every NIH grant supports 6 -7 part-time or full-time jobs
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Challenge Grants• 2 year $500k/yr awards – submitted April 27, 2009• Received >21,000 proposals, 894 for NIMH• Reviewed June-July, Funded before 9/30/09• NIH OD committed $200M; NIMH has committed $90M
NIMH Challenge Areas:BiomarkersGenomic sequencingSchizophrenia interactomeAIDS – behavior changeComparative EffectivenessDeveloping iPS cells
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Grand Opportunity Grants
• 2 year >$500K/yr awards – submitted May 24, 2009
• Received 104 proposals for NIMH ($470M)
• Reviewed June; Funded before 9/30/09
• NIMH has committed $67M
NIMH GO Grants:Genomic profiling of mental disordersNeurodevelopmental genomicsTranscriptional map of developing human brain
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ARRA NIMH RFA:Research to Address the Heterogeneity
of Autism Spectrum Disorders
4 Different mechanisms to address heterogeneity of autism and focus on short-term objectives of IACC Strategic Plan
590 proposals ($500M) submitted May 12; Peer reviewed June 19; Scheduled for Council July 17
Combined commitment is $60M (NIMH, NICHD, NINDS, NIDCR, NIEHS)
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Peer Review for ARRA
Rapid (initial mail reviews within 1 month)
Extensive (364 reviewers for NIMH GO and autism proposals)
Careful (Two tier review to ensure quality)
Public input (Autism review included consumers)
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http://www.nih.gov/recoveryTransparency:
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Accountability: http://report.nih.gov/
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NIMH Signature Project #1
Reducing Suicide in the Army
Problem: Suicide rates in Army have doubled
Army asked for assistance in assessing risk and resilience in soldiers
NIMH commits ARRA funds ($10M) to collaborative effort for historic epidemiological study to follow 15,000 soldiers
Study to provide actionable information to Army
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NIMH Signature Project #2
Recovery After an Initial Schizophrenic Episode (RAISE)
Problem: Schizophrenia associated with chronic disability
RAISE will test aggressive, comprehensive treatment(medication, psychosocial, rehabilitation) to optimize outcomes
RAISE developed with SSA, SAMHSA, and CMS for “hand off” from research to practice
NIMH ARRA funds ($25M) will launch project in 2009
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NIMH Signature Project #3
Neurogenomics
Problem: Many leads but few genes for psychiatric illnesses (rare variants likely but difficult to detect)
New techniques permit rapid, comprehensive sequencing, including detection of rare variants
NIMH ARRA funds ($20 -30M) will support development of first comprehensive sequencing efforts
Sequencing is feasible in 2 years
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NIMH Comparative Effectiveness Research
ARRA Projects:• Leveraging existing healthcare networks for CER on Mental Disorders and Autism
• Cost effectiveness of mental health interventions
• Collaboration with AHRQ CER Program
• Building ASD registries for use in Comparative Effectiveness Research
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What Can We Accomplish With ARRA?
Biomedical Progress: Creating a foundation for future progress
Creating and Preserving Jobs:>50% of grant budget = personnel
Economic Stimulus:Proposals from all 50 states
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NIMH ARRA obligations actual and planned for FY2009
(all mechanisms)
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SummaryARRA provides an unprecedented opportunity to advance biomedical research while participating in the nation’s economic recovery
NIMH is using ARRA funds to jumpstart its strategic plan, support autism and AIDS research, and provide training and faculty positions.
Specific signature projects focus on suicide in the Army, schizophrenia, and genomics.
Demand for ARRA support high, success relatively low, but ARRA will build foundation for progress.
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www.nimh.nih.govwww.nimh.nih.gov
Paving the Way for Prevention, Recovery, and Cure
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Select NIMH ARRA Funds – 7/10/09Initiative Committed
fundingDue Date
Proposalsreceived
Funding Date
Expansion of payline
$60M 2008- 2010
----- 6/09
Supplements
$10M adm.$10M comp.
4/09 $205M$ 64M
6/098/09
Challenge $90M 4/09 $578M
8/09
Grand Opportunity
$67M 5/09 $470M
9/09
New faculty recruitment
$5M 5/09 $25M 9/09
Autism RFA
$30M 5/09 $500M
7/09
Army suicide & RAISE
$35M 2009 $35M 7/09
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What Happens After ARRA?
Demand for research will increase:Success rate (# funded/# proposed) < 10%Many unsuccessful grants return in 2010Both unsuccessful and successful grants return in 2011
Total # ARRA proposals = 1,703Estimated success rate in 2011:
If 50% return: 13.7%If 75% return: 12.2%If 90% return: 11.5%
Required for 20% success rate: 7 -11% increase from FY10 PB