 |
 |
|
|
Judd chaired a special forum at APA's annual meeting in May in San Diego marking the 50th anniversary of NIMH. The forum was a slice of history in itself since it was the first time that the surviving directors--Judd, Bertram Brown, M.D., Herbert Pardes, M.D., Shervert Frazier, M.D., and Frederick Goodwin, M.D.--and current NIMH Director Steven Hyman, M.D., have participated in the same program.
NIMH traces its origins back to the World War II era. As it became evident that there were severe shortages of mental health providers and that the understanding of the causes, treatment, and prevention of mental illness lagged far behind other medical areas, William Menninger, M.D., chief of Army neuropsychiatry, called for federal action.
In 1944 Robert Felix, M.D., became the director of the Public Health Service Division of Mental Hygiene. A proposal for a national mental health program that Felix presented to the U.S. Surgeon General became the basis of the National Mental Health Act of 1946, signed into law by President Harry Truman. The first mental health research grant was awarded a year later, to Winthrop N. Kellogg, M.D., of Indiana University for a project titled "Basic Nature of the Learning Process."
The National Mental Health Act called for the establishment of the National Institute of Mental Health, which began in 1949 with the abolishment of the Division of Mental Hygiene. NIMH was one of the first four institutes in the National Institutes of Health (NIH). Its three-pronged mission encompassed conducting and supporting research on mental illnesses, training, and assisting the states in the prevention, diagnosis, and treatment of mental illness.
One of the high points of NIMH's first two decades was a nationwide assessment of mental health conditions and resources to arrive at a national program to meet the nation's mental health needs. A result of this comprehensive study was the 1963 passage of the Mental Retardation Facilities and Community Mental Health Centers Construction Act under President John F. Kennedy.
Stanley Yolles, M.D., was NIMH's second director (see box below). He presided over the institute's expanded role in supporting community mental health services and its departure from NIH. In a reorganization that took effect in 1968, NIMH was raised to bureau status under the Public Health Service.
Brown followed Yolles as director in 1970. Brown, who was unable to attend the annual meeting forum because of illness, made his presentation on videotape.
Brown noted that he had been a career NIMH psychiatrist. He joined the NIMH Mental Health Study Center in 1960 and later served as special assistant for extramural programs, chief of the Community Mental Health Facilities Branch, and deputy director of NIMH.
Brown oversaw NIMH at an exciting time for psychiatry. Julius Axelrod, M.D., an NIMH researcher, was presented a Nobel Prize in 1971 for research on the chemistry of nerve transmission. Just the year before the FDA had approved the use of lithium for the treatment of mania based on NIMH research. This led to a cost savings of $40 billion over the next couple of decades and a sharp drop in inpatient days and suicides.
In 1973 NIMH underwent another important reorganization with the creation of the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA). ADAMHA subsumed NIMH, the National Institute on Alcohol Abuse and Alcoholism (NIAAA), and the National Institute on Drug Abuse (NIDA).
In 1977 President Jimmy Carter established the President's Commission on Mental Health, chaired by first lady Rosalynn Carter. The commission was charged with reviewing the country's mental health needs and recommending how those needs could best be met.
Brown believes that NIMH's current mission is "too broad, too grandiose." He said he continues to feel, as he did when he headed NIMH, that addressing the nation's mental health needs should be done under NIMH and as a public health concern.
Pardes succeeded Brown in 1978. "I can't think of a more exciting and enjoyable part of my career," said Pardes, who is now dean of the College of Physicians and Surgeons at Columbia University. It was under Pardes's tenure that the Epidemiologic Catchment Area (ECA) study was launched, encompassing more than 20,000 people. That same year--1980--the Mental Health Systems Act, based on a report from the President's Commission on Mental Health, was passed.
Pardes noted that one of his great challenges as director was trying to capture budget money from the Reagan Administration, which believed that the federal government had no role in mental health services.
Reagan's Omnibus Budget Reconciliation Act of 1981 repealed the Mental Health Systems Act and consolidated ADAMHA's treatment and rehabilitation service programs into a single block grant enabling each state to allocate the funds as it saw fit. In essence the federal role in services to the mentally ill became one of providing technical assistance to increase the capacity of state and local providers of mental health services.
Nonetheless, Pardes was able, through tenacious effort, to obtain an increased budget for NIMH and begin NIMH's transition to an institute whose orientation emphasized research over services. Also during his tenure Pardes placed greater emphasis on neuroscientific research and its links to psychiatry, encouraged the growth of consumer and advocacy organizations, and worked for the elimination of stigma surrounding mental illness and its treatment.
Pardes was succeeded in 1984 by Frazier, who believed a significant reorganization of NIMH was needed. Within a year, the extramural research program was aligned to emphasize that the institute's primary mission was now research. This provided for an increased focus on understanding the biological and behavioral underpinnings of mental illness and mental health and for improving the treatment and prevention of mental disorders.
Frazier noted that the ECA data, which began to be published in 1985, changed psychiatric nosology and provided important information about the service requirements of the mentally ill. Moreover, it was under Frazier's tenure that NIMH began major initiatives on schizophrenia and depression.
"NIMH provides a real opportunity to understand the needs of the mentally ill," said Frazier, who holds a senior post at McLean Hospital and is a consultant to the New York Academy of Sciences. "If its first 50 years is a prototype, then its next 50 years will be overwhelming for all of us."
Judd, who succeeded Frazier in 1987, noted that each new director faced a different situation when he assumed NIMH's top post. For Judd, it was another Republican administration with little interest in the country's mental health needs. Like Pardes, however, that did not stop him from fighting for significant increases in budget money to keep psychiatric research moving forward.
When Judd joined NIMH, he had a clear set of goals he wanted to accomplish--prime among them were to establish NIMH as a leading research institute for the neurosciences and to develop national research plans in major areas. Subsequently published were research plans for schizophrenia, neuroscience (the NIMH Decade of the Brain Research Plan), child and adolescent mental disorders, and improvement of services for people with severe mental illness.
It was also during Judd's directorship that NIMH convened for the first time all the major national organizations in mental health to form the National Mental Health Leadership Forum. The forum, represented by each organization's president and executive director, met twice a year from 1988 to 1992, playing a major role in seeking parity for mental disorders in health care reform.
A high point of Judd's tenure came in 1989, when President George Bush signed a proclamation establishing the 1990's as the "Decade of the Brain."
When Judd left NIMH, he returned to his post as chair of psychiatry at the University of California at San Diego.
NIMH's evolution into a research organization was complete when Goodwin was head of ADAMHA. On October 1, 1992, ADAMHA was abolished, and the research components of NIMH, NIAAA, and NIDA were rejoined with NIH. Goodwin was appointed director of the newly reorganized NIMH. NIMH's service components became part of a new Public Health Service agency, the Substance Abuse and Mental Health Services Administration (SAMHSA). SAMHSA's Center for Mental Health Services was created to promote improved advocacy for and linkage of research and services. New offices at NIMH were created for AIDS research, prevention, special populations, and rural mental health. Today NIMH has four research divisions: neuroscience and behavioral science, clinical and treatment research, epidemiology and services research, and intramural research programs.
Goodwin said that he proactively supported the reorganization, believing it would strengthen NIMH's research activities.
"NIMH will continue to be a beacon of light and hope to our field and our patients," said Goodwin, who is now the director of the Center on Neuroscience, Medical Progress, and Society at George Washington University Medical Center.
Hyman, NIMH's current director, noted that his job is to continue the transition begun under Pardes of ensuring that NIMH is in the mainstream of biomedical research. Never has the hope for alleviating the suffering of those with mental illness looked as bright as it does today.
"This is an exciting time," said Hyman. "Our research is at heart the most exciting part of biomedical research in all its articulations." --C.F.B.
(Psychiatric News, July 4, 1997)