The National Institute of Mental Health (NIMH) came under fire last month when a leading mental health advocacy group charged that the agency has not spent enough of its resources on severe mental illnesses.

The National Alliance on Mental Illness (NAMI) and a research foundation that supports NAMI’s mission also criticized NIMH for spending its resources on AIDS, neuroscience, and diverse behavioral research. Other leading advocacy groups, such as APA, were quick to disagree, however.

"NIMH spent only 36 percent of its total research funds on severe mental illnesses in Fiscal Year 1997. It should be two-thirds of the budget," complained Michael Knable, D.O., medical director of the Stanley Foundation Research Programs, in an interview.

Knable said that NIMH should devote more research to severe mental illnesses because 5.6 million Americans from age 9 on up suffer from schizophrenia, schizoaffective disorder, manic-depressive illness, major depression, obsessive-compulsive disorder, or panic disorder.

Knable and E. Fuller Torrey, M.D., the foundation’s executive director, were the principal authors of the controversial report released last month. The conclusions were drawn from a review of 2,277 NIMH-funded research grants for Fiscal Year 1997.

"The results show a shocking failure by NIMH to carry out its primary responsibility on diseases which cost the nation at least $74 billion each year," said Torrey in an NAMI/Stanley Foundation press release.

The coauthors were NAMI’s executive director, Laurie Flynn; John Davis, M.D., a psychiatrist at the University of Illinois; and Irving Gottesman, Ph.D., a psychologist at the University of Virginia.

"These illnesses pose a great threat to public health and have extremely high fiscal and social costs," said Knable.

News of the report, which was publicized in a December 6, 1999, lead article in USA Today, spread quickly throughout the mental health research and advocacy communities last month. Many professional groups, including APA, defended NIMH’s research portfolio in letters to the agency.

NIMH Director Steven Hyman, M.D., said in an interview that the primary mission of NIMH was never intended by Congress to be narrowly focused on six severe mental illnesses.

"We are expected to do research on public health issues of concern to Congress and the American public. For example, this year the emphasis has been on youth violence," said Hyman.

The NIMH cannot abandon research on other illnesses such as attention-deficit/hyperactivity disorder, which occurs in 3 percent to 5 percent of school-aged children; or anorexia nervosa, which has a mortality rate of 10 percent.

"I suspect that the majority of NAMI members are more generous than the principal authors and expect us to do research on many disorders," said Hyman.

The report’s authors criticized NIMH for spending only 12 percent of its Fiscal Year 1997 research budget on clinical- and treatment-focused trials related to severe mental illnesses. NIMH also drew fire for spending at least 15 percent of its total research funds on diseases such as AIDS and Alzheimer’s, which are the primary responsibility of other federal research institutes. "NIMH spent more on AIDS research ($60 million) than on schizophrenia research ($57 million) in Fiscal Year 1997," claimed Knable

Hyman said that 80 percent of the non-AIDS research budget ($440 million) in Fiscal Year 1997 was spent on research relevant to mental illness or its underlying brain and behavioral science.

Hyman explained that Congress appropriates restricted funds for AIDS research to the National Institutes of Health for distribution to the various institutes. "I am surprised that the report’s principal authors would question our use of AIDS funds because they know we cannot spend them on non-AIDS research," he observed. "It’s unfortunate that the report pits funding for one highly stigmatized group against another."

Another charge leveled by the authors is that NIMH funded numerous behavioral research projects that have no relevance to severe mental illnesses. "NIMH supported everything in Fiscal Year 1997 from reading problems to the behavioral endocrinology of prairie voles," claimed the authors in a press release.

Hyman responded that many of these behavioral projects were already funded when he arrived at NIMH in late 1996 and that, given a choice, he would not have funded many of them. Nonetheless, he said, "it’s disingenuous to pick out the funniest titles from our research portfolio and say they have no relevance to severe mental illnesses. The prairie voles are the best animal model for determining whether a single gene mutation also found in human beings causes the negative symptoms of autism and schizophrenia."

The authors recommend that NIMH transfer funds used for basic neuroscience research to research on severe mental illnesses because it would have little impact on the former and greatly benefit the latter, according to the report.

Hyman vehemently opposed that idea. "If we just do clinical research, we will not find a cure for anyone with schizophrenia. We can only do this by understanding the fundamental biology of the brain and what goes wrong to produce mental illness."

Knable credited Hyman with devoting more resources to severe mental illnesses since Fiscal Year 1997. NIMH has funded four large-scale clinical studies on schizophrenia, bipolar disorder, treatment-resistant depression, and adolescent depression, according to the NIMH press release.

But Flynn cautioned in the joint press release, "We’ve seen only the beginning of what needs to be done to return NIMH back to its original mission."

The report, titled "The Failure of the NIMH to Do Sufficient Research on Severe Mental Illnesses," is available at NAMI’s Web site at <www.nami.org/pressroom/forgotten.html>.