A. It’s an exciting time for mental health research — the last five years, especially, have resulted in findings that are transforming the fields of neuroscience and mental health care. For example, in basic science, we have now identified hundreds of places in the genome that are linked to mental disorders such as schizophrenia, autism and depression. The NIH Brain Research through Advancing Innovative Neurotechnologies® (BRAIN) Initiative is also generating exciting results, including new tools and resources that have dramatically increased our ability to study the living brain.
In the translational sciences, we recently celebrated the U.S. Food and Drug Administration’s approval of two of the first truly novel antidepressants in decades: esketamine for treatment-resistant depression, and brexanolone for postpartum depression. And in intervention research, NIMH-sponsored studies have demonstrated the utility of coordinated specialty care for treating first-episode psychosis and the importance of universal screening and follow-up care for those at risk for suicide.
These are only a few of the exciting advances coming out of basic, translational and intervention research. At NIMH, we’re proud of how far the field has come and excited for the future of mental health research.
Q. One of the areas of research that you’ve championed is suicide. What can you tell us about the strides that have been made?
A. Suicide rates continue to rise in the U.S., and reversing this trend will require that we take the evidence-based practices we know are effective and learn how to implement them on a large scale.
Identifying those at risk for suicide is a critical first step. One effective strategy, according to NIMH-funded research, is universal screening in healthcare settings. With this approach, healthcare providers use screening tools such as the Ask Suicide- Screening Questions (ASQ) to quickly identify at-risk patients who may need further intervention. NIMH staff and other researchers have worked to identify clinical pathways that can guide the implementation of universal screening in healthcare settings in a way that is flexible and mindful of limited resources.
NIMH-funded research is also investigating complementary approaches to risk identification, including algorithm-based risk-prediction models. These advances in risk detection are especially noteworthy, as data suggest that screening, combined with low-cost interventions — such as follow-up phone calls and postcards — were projected to lead to a decrease in suicide attempts in the following year.
But having evidence-based identification and intervention practices are not enough: We also need to ensure these practices are being utilized by the healthcare community. That is why we need to continue to collaborate with public and private partners, advocacy organizations, accrediting organizations such as the Joint Commission, and policymakers to increase the uptake of those practices we know to be effective and to learn more about the best ways to implement them in real-world settings.
Through our collaborative efforts and our continued investment in clinical science, NIMH is committed to achieving the collective goal of saving lives and reversing the trend in suicide rates in the U.S.
Q. Your emphasis on turning science into practice with the RAISE (Recovery After an Initial Schizophrenia Episode) studies is changing the lives of individuals and families affected by early psychosis. Can you talk about this remarkable success and what it taught you?
A. The RAISE study demonstrated the superiority of team-based, multi-component coordinated specialty care (CSC) over usual care when treating early psychosis. It also demonstrated the feasibility of implementing CSC programs in U.S. community settings. RAISE is an example of what we strive for at NIMH — the transformation of sound science into real-world change.
The success of the RAISE study prompted Congress to allocate millions of additional dollars to the Community Mental Health Block Grant Program administered by the Substance Abuse and Mental Health Services Administration (SAMHSA). Between 2014 and 2019, SAMHSA disbursed approximately $286 million to states and territories to foster rapid implementation of evidence-based CSC programs. CSC is now the standard of care for early psychosis, with 285 CSC programs for first-episode psychosis operating in the U.S. as of 2018.
The RAISE study shows what can be achieved when the research community, the private and public sectors, advocacy organizations, healthcare professionals and policymakers work together to promote the practices we know to be effective.
Building on the successes of RAISE, NIMH is pioneering the Early Psychosis Intervention Network (EPINET), a research network that will use data from community-based first episode psychosis clinics to enhance the delivery, evaluation and continual improvement of evidence-based care. We hope EPINET will serve as the next chapter in this success story.
Dr. Gordon will be speaking at NAMICon, a free, virtual event, on the challenges and opportunities in mental health research. You can register on the NAMICon page.
This piece was originally published in the Spring 2020 issue of Advocate.