A work group convened by the citizens’ advisory board that oversees the National Institute of Mental Health (NIMH) has recommended that the institute put more effort into assuring that the behavioral research it supports can be applied to alleviating mental illness.

In its report, which was published last month, the National Advisory Mental Health Council’s (NAMHC) behavioral science work group implicitly criticized NIMH for failing to support enough clinically relevant basic behavioral and social science. According to the report, underlying processes have not been sufficiently explored. Even when behavioral science findings might be used to improve interventions, they have not been applied clinically.

One reason for this neglect, in the view of NIMH Director Steven E. Hyman, M.D., is "a fundamental lack of appreciation" of the potential clinical impact of behavioral science research. "It’s almost a kind of disrespect," he said.

The work group’s detailed report advocates that studies in three areas of interest should receive more funding: How basic behavioral processes, such as motivation, cognition, and social interaction, are altered in mental illness. Of interest are how these processes relate to neurobiological function and how they affect etiology, diagnosis, course, prevention, treatment, and rehabilitation; how individuals are affected at home, in school, and at work by mental illness and its treatment; and how social and other environmental contexts influence the etiology, treatment, and prevention of mental illness.

The report noted that the three priorities "are so central to the core mission of NIMH that it may seem puzzling that the work group needs to highlight them for special encouragement." Despite the obviousness of the questions, "such research is sparse at best in the current NIMH portfolio, suggesting that these are difficult areas to develop."

The report calls on the scientific community to do research on topics considered important by consumers, family members, providers, and payers. It advocates better communication and collaboration between basic scientists and clinical and services researchers. Part of this effort would include more support of "translational research," which is aimed at understanding how findings from basic research can impact on applied research and vice versa. At present few researchers try to bridge across basic, clinical, and services research, according to the report.

The work group notes that all three priority areas "will benefit from a systematic, phased approach to development that assesses their current status and needs, their potential contributions to clinical care and service delivery, and the steps required to realize those contributions." Topics within each area will require different strategies and timetables, however, since each is at a different stage of development.

The work group cites the NIMH AIDS research program as a model of a phased approach to developing a successful program. The AIDS program, it says, "has had a palpable impact on the careers of many basic behavioral scientists, encouraging them to broaden their perspective beyond basic animal research or studies of normal human populations to include observational and intervention studies of ill people or people at high risk of illness."

In a set of 12 steps that comprise an action plan for implementing its recommendations, the work group suggests giving translational behavioral science priority in funding, stimulating NIMH-funded research centers to support such work, developing innovative approaches to supporting translational research, and improving the peer review process for such research. Also recommended are information dissemination and training strategies, more appropriate and rapid funding of worthy projects, and development of better methods for translating research findings and incorporating research results into policy for delivering mental health services. Identifying specific treatments for different disorders, individuals, and circumstances is another step recommended by the work group. It also suggests additions of part-time consultants and visiting specialists to the NIMH staff and monitoring the effectiveness of the institute’s efforts.

NIMH Director Hyman said that one of the first steps he plans to take in implementing the work group’s recommendations is to create partnerships among basic behavioral scientists, clinical investigators, and health services researchers. Various mechanisms are available for creating such partnerships, he noted. Among them are requests for research applications, program announcements, and workshops. Reaching out to the field is also necessary because, Hyman said, he recognizes that challenging interdisciplinary science doesn’t grow up overnight.

Paralleling the NIMH work group is a committee of the Institute of Medicine, noted Hyman. That committee is exploring how to develop young scientists who are able to "bridge this gulf between basic behavioral science and other important areas of science."

The theme that pervades the work group report is the need for social and behavioral scientists to serve NIMH’s clinical goals by producing results that will improve the lot of the mentally ill. Promising avenues of research are noted, along with brief descriptions of provocative results from recent studies. Among them:

• Memory, emotion in schizophrenia: Memory for personal events, so-called episodic memory, appears to be deficient in individuals with schizophrenia. This finding may be useful in designing cognitive rehabilitation programs. Beliefs about emotional flatness in schizophrenia are being challenged by another new line of research. Although facial expression of emotion was found to be dampened, autonomic nervous system responses were the same or greater as those of control subjects.

• Brain plasticity and behavior: Research has shown that experience, including psychotherapy, can change brain physiology. Even the size of brain ventricles, an index of brain dysfunction in several disorders, has been shown to change with experience and nutritional status.

• Genetics and behavior: Genetic evidence suggests that several mental disorders do not divide into neat categories, but are instead arrayed along continua of severity and other characteristics. Careful description of behavioral phenotypes is critical to understanding the multiple genes linked to mental illness, the interaction of those genes with each other and with the environment, and other genetic issues.

• Social interaction in severe mental illness: Individually tailored cognitive-
behavioral methods, combined with medication, have been shown to reduce relapse and improve social functioning significantly among mentally ill persons living with their families.

The work group, which met from March through November of 1999, augmented its six meetings with conference calls, subgroup meetings, reports of similar committees, and consultations with scientists and research administrators. Members included some NAMHC members, researchers, and mental health advocates. Council member Anne Petersen, Ph.D., of the W.K. Kellogg Foundation, served as chair. Robert Levenson, Ph.D., of the University of California at Berkeley, served as cochair, and Jane A. Steinberg, Ph.D., of NIMH, was executive secretary.