Strategic Plans and Priorities

• Setting Priorities
• Investing for High Impact
• Research Training
• New Organizational Structure at NIMH

The NIMH mission is to reduce the burden of mental and behavioral disorders through research on mind, brain, and behavior. Our goal is to generate research that will transform prevention of and recovery from mental disorders. To achieve this, especially in a time of fiscal restraint, we are setting strategic priorities for the institute. While this is a departure from the way things have been done in the past, redefining our focus now is imperative. Identifying our priorities and reorganizing our internal structure will help us exploit the enormous scientific gains that have already been made and help us focus on cross-disciplinary collaboration as a means of accomplishing our goals.

The most important reason for change is that basic science now provides us with unprecedented opportunities to define the pathophysiology of mental disorders and to develop new interventions. Our highest priorities must be:

• supporting basic science discoveries;
• translating these discoveries into new interventions that will relieve the suffering of people with mental disorders; and
• ensuring that new approaches can be used for diverse populations and in diverse settings.

Despite a decelerating budget, we still have more funds (roughly $1.4 billion in FY2004) and we are funding more grants (more than 3,000 research project grants in FY2004) than at any time in our history. We have not only the scientific opportunity but also the funds to support the science that will have an impact on mental and behavioral disorders. We need to invest these funds strategically to maximize this impact.

Setting Priorities

To set priorities, we:

• solicited input from our various stakeholders—patients and their advocates, physicians/scientists and their professional societies, Congress, and the National Advisory Mental Health Council (NAMHC), which includes public members;
• requested workgroups of our Council review our portfolios in basic science and clinical trials and recommend priority areas for future investment;
• identified priority areas for funding within each extramural program division, based on divisional review of existing and new proposals.

In this effort, we have attended to three factors: relevance, traction, and innovation.

Relevance refers to relevance to the mission. Not every grant must focus on a specific disorder, nor will only clinical research be funded. NIMH will continue its strong support of basic science, but as the NAMHC workgroup recommends in its report http://www.nimh.nih.gov/council/brainBehavioralScience.cfm some research areas are more relevant than others. As one example, the workgroup stressed the need for more information about the neurobiology of adolescence, recognizing that many mental disorders begin during this phase of development but relatively little is known about the concurrent changes in brain function.

Traction refers to the capacity for rapid progress in research areas where new tools, such as high throughput genotyping or 2-photon imaging, can yield definitive answers to long-standing, relevant questions.

Innovation is often endangered during periods of limited budget growth. The innovative project that lacks extensive pilot data often is considered too risky for funding. This is the era of "discovery science," with the tools to identify the major candidate genes, cells, and systems involved in emotion, cognition, and behavior. This work is highly relevant and we have the traction, but unless a priority is placed on discovery science, this unprecedented opportunity for innovation may not receive the support it deserves.

As a result of our priority-setting discussions with stakeholders and Council workgroups, a list of priorities for each extramural Division will soon be posted on the NIMH web site to guide grantees to areas of investment. High priority will go to studies of the pathophysiology of mental disorders and studies that may lead to new interventions aimed at reducing the burden. Much of the basic science we will fund may not be immediately ready for translation; yet it will address basic questions about behavior, brain, and experience that are informed by and, in turn, inform the understanding of mental disorder, recovery, or resilience. For additional guidance on priorities and areas of investment, our program officers can be reached by phone or e-mail.

Investing for High Impact:

Setting priorities is useful only if we can ensure that funding follows suit. To achieve this, we will:

• Change referral guidelines, which are the description of the specific areas of science that NIMH supports. Some scientific areas that NIMH previously funded are within the core mission of other institutes and, in the future, should be referred accordingly. For instance, grants on visual sensory processing belong to the National Eye Institute; most studies of communication belong to the National Institute of Deafness and Communication Disorders; and much of the research on normal development including parenting, marriage, and family is central to the National Institute of Child Health and Human Development. There will be exceptions to these guidelines based on the focus of individual proposals, but as a general rule, NIMH will use referral guidelines to focus its portfolio.
• Adjust the payline to provide funds for high priority areas. We expect that the payline will drop below the 15th percentile to allow the Institute to sequester funds that can support grants of special interest in the 15th to 25th percentile range.
• Use RFAs and strategic initiatives, as we have in the past, to ensure that funds are available for high priority needs. This is particularly relevant to our commitment to innovation. Some funding will be appropriated each year to support the most promising high-risk, yet potentially high-yield grants. These funds will also be used for the NIH Roadmap and the Neuroscience Blueprint, two multi-institute initiatives to build tools and infrastructure serving all of biomedical research, ranging from molecular libraries to clinical trials.

Research Training

Training the next generation of investigators has always been a high priority for NIMH. Indeed, NIMH spends roughly 10 percent of its budget on training, twice that of most other institutes. With lower paylines for research project grants, one might ask if continuing this large commitment to training is unwise. Are we training too many young investigators for the available dollars for research grants (i.e., R01s)?

The paradoxical answer to this question is there are many areas of mental health research that are seriously under-populated. The question, therefore, is not how to reduce training but how to redirect training to ensure the best talent in the fields requiring the greatest research capacity. The need is not discipline-specific: New scientists are needed in a range of areas, from informatics and imaging to child psychopathology and service research. The NIMH plan is to strategically reduce training slots and decrease slightly the percentage of the NIMH budget invested in training, but, as with the research budget, invest these funds to support those areas most relevant to the Institute's mission.

A New Organizational Structure at NIMH

One of the fundamental recommendations that has emerged from public comment, Council workgroups, and discussions with NIMH program officers has been the need to translate basic science discoveries into biomarkers, diagnostic tests, and new treatments for patients with mental disorders. To increase the focus on translation, NIMH is reorganizing its extramural programs into five research divisions, including basic science, translational research for adults, as well as children and adolescents, health and behavior (including AIDS), and services and intervention research.

We have shifted several areas of basic science, such as studies of emotional regulation or cognitive development, to new translational divisions to accelerate the development of tools to help patients. To work toward a long-term goal of personalized care, we are establishing new programs focusing on translating basic research into intervention development. Several current high priority areas, such as genetics and molecular, cellular, and behavioral neuroscience, will remain high priority areas. At the other end of the research spectrum, the Institute will continue to invest in practical clinical trials and services research. A key aspect of our reorganization is ensuring translation of the best ideas between divisions.

This is a time of great scientific excitement for mental health research. Building on the Decade of the Brain, we are poised for a Decade of Translation, with new discoveries from genomics, neuroscience, and behavioral science leading to new, more effective treatments, and ultimately to the possibility of preventing and curing mental illness. Our priority setting, new funding strategies, and new organization are designed to optimize the translation of our best science to the service of those with mental and behavioral disorders.

Previous Reports

• Breaking Ground, Breaking Through: The Strategic Plan for Mood Disorders Research, July 2002.
  Summarizes the current state of the science on major depression and bipolar disorder across the life span, as well as recommendations of research priorities to achieve scientific goals.
• Pathways to Health: Charting the Science of Brain, Mind, and Behavior (PDF file, 75 pages), 2002.
  The first research strategic plan developed to help the NIMH set priorities and future directions for research on mental disorders and mental health.
• NIMH Five-Year Strategic Plan for Reducing Health Disparities (PDF file, 33 pages), November 2001.
  This 5-Year strategic plan for reducing health disparities priortizes ongoing research, research training/capacity building and public information outreach and dissemination activities.