NAMHC Minutes of the 265th Meeting
September 14 & 15, 2021
Department of Health and Human Services
Public Health Service
National Institutes of Health
National Advisory Mental Health Council
Introduction
The National Advisory Mental Health Council (NAMHC) held its 265th meeting at 12:00 noon, September 14, 2021 via a virtual videocast. In accordance with Public Law 92-463, the session was open to the public until approximately 4:05 pm and closed thereafter for consideration of grant applications. The closed session was held on September 15, 2021 from 11:00 am until 3:30 pm. Joshua Gordon, M.D., Ph.D., Director of the National Institute of Mental Health (NIMH), presided as Chair.
Chairperson
Joshua Gordon, M.D., Ph.D.
Executive Secretary
Tracy Waldeck, Ph.D.
Members Present
- Laura Almasy, Ph.D.
- David Goldstein, Ph.D.
- David Henderson, M.D.
- Kamilah Jackson, M.D.
- Cheryl King, Ph.D.
- Yael Niv, Ph.D.
- Neil Risch, Ph.D.
- Brandon Staglin, M.S.
- Joseph Telfair, DrPH, M.P.H
- Sophia Vinogradov, M.D.
- Hongkui Zeng, Ph.D.
Department of Veteran Affairs (Ex Officio Member)
- Amy Kilbourne, Ph.D., M.P.H.
Liaison Representative
- Anita Everett, M.D.
Other Employees Present (see page 13).
OPEN PORTION OF THE MEETING
I. Open Policy Session Call to Order & Opening Remarks, Joshua Gordon, M.D., Ph.D.
NIMH Director Dr. Joshua Gordon opened the meeting and welcomed Council members, NIMH staff, NIH staff, and members from various stakeholder communities. Public comments were collected in written format and distributed to Council members prior to the meeting (See Appendix A).
Following introductions, the Council unanimously passed a motion approving the final Summary Minutes of the May 2021 and August 2021 meetings.
II. NIMH Director’s Report, Joshua Gordon, M.D., Ph.D.
A. Congressional Interactions with NIMH
Dr. Gordon reviewed recent congressional interactions with NIMH. In May 2021, NIMH participated in a virtual roundtable discussion with Senator Ben Cardin (D-MD) and Representative David Trone (D-MD) on the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on mental health and addiction in Maryland. In July 2021, NIMH and the National Institute of Neurological Disorders and Stroke (NINDS) convened a joint briefing on suicide and Long COVID with staff from the offices of Representatives Anthony Gonzalez (R-OH) and Adam Kinzinger (R-IL). That same month, NIMH participated in a briefing with Representative Paul Tonko (D-NY) on mental health priorities and COVID-19 research, as well as a separate congressional briefing organized by the Friends of NIMH, during which experts highlighted NIMH-funded bench-to-practice advances supported by NIMH in recent decades.
B. Legislative Updates
On May 25, Francis Collins, M.D., Ph.D., NIH Director, and several other Institute and Center Directors of NIH testified before the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies on issues related to the fiscal year (FY) 2022 budget request. The next day, a separate group of NIH Institute and Center Directors testified before the Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies on the FY 2022 budget request and the state of medical research.
C. Budget and Appropriations Update
Dr. Gordon explained that NIMH has maintained a steady success rate in the low 20 percent range since 2015, but this has decreased slightly—a decline he attributed to an increasing number of applications for NIMH and increasing average costs per grant. At the current funding level, NIMH has been able to award approximately 600 grants per year for several years.
Dr. Gordon also noted plans for a new NIH agency, the Advanced Research Projects Agency for Health (ARPA-H) . Analogous to the Department of Defense’s Defense Advanced Research Projects Agency (DARPA) , ARPA-H would operate independently and in collaboration with NIH and other Institutes to speed the progress of biomedical innovation including an emphasis on mental health.
At the time of this meeting, the House had already passed their version of the NIH budget, which includes an increase of $6.5 billion to NIH, $3 billion of which is allocated to ARPA-H. If passed, NIMH’s budget would receive $2.223 billion, $119 million above the FY 2021 enacted level. Dr. Gordon explained that such an increase would enable NIMH to maintain and potentially increase success rates while more generously funding initiatives related to COVID-19 health impacts and disparities.
D. NIH Updates
Dr. Gordon reviewed NIH-wide initiatives and leadership news. From June 15-17, 2021, NIH held the 7th Annual Brain Research through Advancing Innovative Neurotechnologies® (BRAIN) Initiative Investigators Meeting , which featured online posters, exhibits, networking, and a dialogue session.
In partnership with NINDS and the National Heart, Lung, and Blood Institute (NHLBI) , NIMH is participating in a study of the post-acute sequalae of SARS-CoV-2 infection (PASC) called the Researching COVID to Enhance Recovery (RECOVER) Initiative . RECOVER intends to understand, prevent, and treat PASC.
In leadership news, Marie Bernard, M.D., has been selected as the next NIH Chief Officer for Scientific Workforce Diversity, and Michael Gottesman, M.D., will step down as NIH Deputy Director for Intramural Research after 28 years of service.
Dr. Gordon addressed several issues of ongoing concern for the Council. First, he reported his commitment to reduce racial/ethnic and gender disparities in NIMH funding rates. He presented data aggregated from NIMH competing applications on a yearly basis for FY 2011-2020, excluding training-related applications as well as applications in special project areas such as the BRAIN Initiative and the Helping to End Addiction Long-term Initiative (HEAL)℠ Initiative .
Over the last decade, there has been a modest increase in the proportion of applications submitted to NIMH supporting female principal investigators (PIs) and an increase in the proportion supporting PIs not reporting a gender. The difference in award rates between applications supporting male and female PIs appears less pronounced than in past years.
There has been a modest increase in the number of applications supporting Black PIs, although such applications still remain a small percentage of the NIMH portfolio. Concerningly, applications supporting Black PIs have a lower eventual award rate as compared to applications supporting their White counterparts, although the eventual award rate among these applications has increased over the last three years. In 2020, the award rate for applications supporting Black PIs approximated that of White PIs. Likewise, there remains a substantive difference in award rates among non-Hispanic PIs and Hispanic PIs, suggesting another area for future improvement.
Dr. Gordon also discussed workforce initiatives to retain individuals through their critical life events, such as childbirth, adoption, and caregiving. Dr. Gordon described two Notices of Special Interest for administrative supplements to promote research continuity, which have been spearheaded by the Office of Workforce Diversity and Disparities Research.
Dr. Gordon then addressed the NIH Special Council Review (SCR) Policy, which requires SCR of research applications from well-funded investigators who have already received $1 million or more in direct cost per year of NIH funding to support research project grants. The proposed revision to the NIMH SCR procedures aim to further ensure effective management of resources and to support unique opportunities or highly promising work that is distinct from already funded research. The revised guidance would apply to investigators receiving more than $1.9 million total costs (including approximately $1.2 million in direct costs) of research project grant support at the time of Council. Applications from these investigators would only be considered for funding by exception, which will be recommended by program staff and concurred by Council.
Dr. Gordon reviewed recent updates to the NIMH Strategic Plan for Research. The 2021 updated Plan continues to emphasize investments in the research workforce and research on mental health disparities, while also highlighting new efforts, such as Accelerating Medicines Partnership® - Schizophrenia (AMP® SCZ). In addition, it includes an updated Message from the Director and a new section on COVID-19.
Dr. Gordon also provided updates on the Interagency Autism Coordinating Committee (IACC) . Susan Daniels, Ph.D., has been appointed Acting National Autism Coordinator during the search for a permanent replacement for Ann Wagner, Ph.D., who retired from federal service in recent months. In July 2021, the newly appointed IACC held its first full Committee meeting since its reauthorization last year. IACC topics for discussion included COVID-19, racial equity, and health disparities in the context of autism. The next meeting will occur in October 2021.
Last, Dr. Gordon announced staff news and awards. Anna Ordóñez, M.D., M.A.S., Deputy Director of the NIMH Office of Clinical Research, was selected as the Director of the NIMH Office of Clinical Research following a nationwide search. Next, he noted that Becky Wagenaar-Miller, Ph.D., has transitioned from NIMH to the National Institute on Deafness and Other Communication Disorders , where she now serves as the Director of the Division of Extramural Activities. Dr. Gordon also highlighted a number of staff awards.
F. Science Highlights
Dr. Gordon shared four science highlights from NIMH-support research. The first study examined attention and the prefrontal cortex (PFC) in mice. This study used a classic behavioral test that requires the mouse to pay attention and react to five areas on a screen in which a light could appear. The test enables researchers to study attention separately from other factors that may contribute to behavior, such as motivation. Using an optogenetic tool to manipulate neuronal activity, the researchers determined that projections from the PFC region are crucial in modulating the visual cortex to accomplish the attention-based task. The study represents important progress in scientific understanding of the circuitry underlying attention and its effect on responses to external stimuli.
Second, Dr. Gordon discussed a study about the relationship between Zero Suicide organization best practices in outpatient mental health clinics and suicidal behavior. The Zero Suicide Initiative is a systems-focused effort to reduce suicides that involves seven key components (e.g., management, clinical issues) and emphasizes policy and procedures through a continuous quality improvement plan. Researchers studied 110 clinics implementing the Zero Suicide approach and found a significant association between high fidelity to Zero Suicide principles and reduced suicide events (attempts or deaths). These findings suggest that the Zero Suicide approach is effective in real-world settings and that efforts to enhance adherence and fidelity, especially to the quality improvement plan, can improve outcomes.
The next highlight was a Global Positioning System (GPS) study of preexposure prophylaxis (PrEP) uptake and adherence among young gay, bisexual, and other sexual minority men in New York City. Researchers used GPS signals from smartphones carried by participants to map out each participant’s movement space. They also constructed a map of each participant’s residential location that accounted for local transportation patterns and availability of PrEP providers in the locality. The researchers found that the number of PrEP providers in the area in which an individual resides did not correlate with PrEP use, but saw a 10 percent increase in the likelihood of PrEP use based on areas of local travel, indicating that PrEP providers would be most effectively located in areas where people go to work, shop, eat, and engage socially.
Last, Dr. Gordon highlighted a collaboration between two labs in the NIMH Intramural Research Program – Mario Penzo. Ph.D. (Unit on the Neurobiology of Affective Memory) and Yogita Chudasama, Ph.D. (Section on Behavioral Neuroscience) – that addressed complex behaviors in response to a frightening stimulus, which has tremendous implications for the treatment of anxiety disorders and psychiatric disorders more generally. The research team found that projections from the paraventricular nucleus of the thalamus mediated animals’ response to a noxious stimulus, thus influencing the adaptive behavior an animal displayed – avoid or freeze. Researchers could increase or decrease the likelihood of avoidance or freezing by blocking activity in these projections. This basic research may inform the development of targets and treatments for humans with anxiety disorders, which underlie maladaptive responses to anxiety or fear.
Discussion
Neil Risch, Ph.D. asked whether NIMH has examined gender and race/ethnicity of members of NIH peer review study sections. Dr. Gordon said this has been studied extensively and the data are available on the Center for Scientific Review (CSR) website. There remain relatively few individuals of color, particularly Black and Hispanic individuals, on many study sections. CSR has developed a database of reviewers to collect a larger group of individuals by topic area, offering a broader array of reviewers to avoid overburdening the same few people.
III. NIH UNITE: Together We Are Stronger, Marie Bernard, M.D., Ph.D., NIH Chief Officer for Scientific Workforce Diversity
Marie Bernard, M.D., Ph.D. discussed the UNITE initiative , which was established to identify and address structural racism at NIH and in the broader scientific community.
NIH unveiled the UNITE initiative on February 26, 2021. The initiative represents five interacting workstreams: Understanding stakeholder experiences through listening and learning; New research on health disparities, minority health, and health equity; Improving the NIH culture and structure for equity, inclusion, and excellence; Transparency, communication, and accountability with stakeholders; and improvements to the Extramural research ecosystem.
UNITE began with a series of recommendations that saw tremendous progress in the first four months of the initiative. NIH identified a need to publicly commit to identifying and correcting any NIH policies or practices that may perpetuate structural racism. Other goals included the development of a sustainable process to systematically gather and make public the demographics of the NIH workforce and the NIH-supported research workforce. In addition, the UNITE initiative catalyzed the development of an Anti-Racism Steering Committee, which is charged with examining policies and procedures at NIH that may interfere with equity. As of this meeting, the Steering Committee includes 515 members across NIH.
UNITE aims to establish programs to spur institutional culture change in support of inclusivity and equity. One of the premier programs is the Faculty Institutional Recruitment for Sustainable Transformation (FIRST) program, which replicates the development of self-reinforcing communities of researchers, and institutional culture change of the NIH Distinguished Scholars Program at academic and research institutions. Other efforts aim to increase career opportunities for underrepresented groups in recognition that science identity develops at a young age. For example, UNITE encourages all Institutes and Centers to join the National Institute of General Medical Sciences (NIGMS) in their Science Education Partnership Award (SEPA) program , which targets K-12 STEM education. Future programs will also expand interactions with and in support of historically black colleges and universities (HBCUs), tribal colleges and universities, and other minority-serving institutions (MSIs).
UNITE has published revised NIH internal guidance for reporting racial discrimination. They also have published a notice that NIH is concerned about harassment and discrimination as contributors to unsafe or hostile work environments affecting NIH-funded projects. Individuals can report these concerns here .
A more detailed summary of the UNITE Initiative was published in Cell on June 10, 2021, and a current list of the more than 80 volunteers working on this project is now available.
Discussion
Joseph Telfair, DrPH, M.P.H. expressed gratitude for UNITE’s work and asked about considerations related to intersectionality. Dr. Bernard said that the official focus of UNITE is to address structural racism, which includes intersecting marginalized identities (e.g., a disabled person of color). She has been impressed by the activities of the Advisory Committee to the Director Working Group on Diversity , which includes a Subcommittee on Disabilities. Dr. Telfair asked that UNITE consider documenting these policy decision and action steps to ensure that intersectionality and similar concerns are not overlooked.
Yael Niv, Ph.D. pointed out that universities play a substantial role in institutional culture at NIH and cited Dr. Tema Okun’s comparisons between cultures of white supremacy and academia. For instance, NIH analyzes research output from large, well-funded labs but rarely examines team-building output. Dr. Niv encouraged NIH to think outside the box in terms of defining a healthy academic culture. She mentioned that the Academics for Black Survival and Wellness courses are an excellent resource for spurring culture change in academia. Dr. Bernard reiterated that the FIRST program was established to create cultures of inclusive excellence. Another NIH effort is the inclusion of the Plan to Enhance Diverse Perspectives , a requirement which already is included in the BRAIN Initiative Request For Applications (RFAs) and will be present in other RFAs going forward.
Mr. Brandon Staglin was glad that there are efforts to address discrimination among individuals with disabilities. He asked whether UNITE has considered neurodiversity from a strengths-based perspective that recognizes that neurodiverse people offer unique perspectives and assets to mental health research and to society more generally. Dr. Bernard said that the Disabilities Subgroup has been charged to think about disability in all its potential manifestations, including neurodiversity.
Dr. Risch asked how UNITE intends to address the social hierarchy of science (e.g., valuing basic “hard science” over “soft science”). Dr. Bernard emphasized that the UNITE Initiative is an “ultramarathon” that aims to systematically change structures that have existed for decades. One mechanism to correct hierarchy is to change what NIH funds by prioritizing health disparities, minority health, and health equity research. Funding Opportunity Announcements (FOAs) will encourage Institutes and Centers to focus on these areas.
Sophia Vinogradov, M.D. pointed out that the hidden agenda of any social structure is for those in power to remain in power. Privileged groups must acknowledge that they will have to give up some of their power to achieve health equity.
Cheryl King, Ph.D. noted important progress in the conceptualization of these efforts. In the past, minority and marginalized groups were encouraged to behave differently to succeed in a culture that is not tailored for them. Now, the focus is on changing institutional culture to embrace different ways of being and to help all people from different backgrounds achieve success. She then asked about the performance indicators that UNITE plans to capture. Dr. Bernard said these standards will cascade down all leadership. The goal is to identify and address the processes that foster inequities.
IV. COVID-19 Mental Health Research Update, Susan Borja, Ph.D.
Dr. Susan Borja provided an update on ongoing mental health research related to COVID-19. The scope of these efforts include several populations and areas of science: the direct impacts of the virus on the brain, elevated COVID-19 risk among people with mental disorders, and pandemic-related exacerbations in mental illness more generally. To date, NIH has received nearly $4.9 billion in COVID-specific appropriations, $5.5 million of which has been devoted to projects at NIMH.
NIH has released and recently updated a COVID-19-specific strategic plan to communicate broad priorities in COVID-19 research across different funding streams. The first four priorities focus primarily on the virus itself (SARS-CoV-2) and its direct impacts, including efforts to improve fundamental knowledge of SARS-CoV-2 and to advance research in detection, treatment, and prevention. The fifth and final priority is to address disparate COVID-19 outcomes in vulnerable populations, which is particularly relevant to the NIMH mission. Dr. Borja highlighted a Rapid Acceleration of Diagnostics-Underserved Populations (RADx-UP) project, which is testing two interventions: (1) a culturally tailored, age-specific, motivational interview intervention to promote testing for SARS-CoV-2 and mitigate disease risk behaviors and (2) a text-based monitoring system for COVID-19 symptoms to shorten time between symptom onset and testing.
Researchers have also determined that patients with a recently diagnosed mental disorder were at higher risk for SARS-CoV-2 infection than patients without a mental disorder after adjusting for medical comorbidities. Individuals who have a mental disorder and are also African American, a woman, or older seem to be at even greater risk for SARS-CoV-2 infection. Research was conducted to understand the impact of the virus on the development of mental illnesses and other neurological conditions. Substantial neurological and psychiatric morbidity is present in the six months following infection, particularly among patients with severe COVID-19.
Dr. Borja talked about the RECOVER initiative, which was established to understand, prevent, and treat PASC. The American Rescue Plan included $1.15 billion in supplemental appropriations to continue this important work. The RECOVER initiative supports research to assess neuropsychiatric and mental health conditions in development as well as other system impacts in the body.
Research also shows that, beyond those directly experiencing COVID-19, there are broader impacts of the pandemic, such as increased incidence of mental illness. The U.S. was experiencing mental health provider shortages prior to the pandemic, and these shortages have exacerbated challenges in meeting mental health needs. Although telehealth services have expanded rapidly during the pandemic, increasing from 2.2 percent of service use for mental health conditions in January 2020 to 65 percent in April 2020, many regions remain underserved. NIMH is studying the impact of telehealth on policy changes and potential disruptions to care, with a focus on potentially disadvantaged groups. Other digital health approaches, including app-based approaches, are also being examined.
NIMH also supports several research projects on community-level interventions to address COVID-19. REstoring mental health after COVID-19 through commUnity-based Psychological services in New York City (RECOUP-NY) is a hybrid effectiveness implementation trial of an intervention called Program Management Plus, designed for delivery by non-mental health specialists in the community during humanitarian emergencies. Furthermore, NIMH is one of 21 Institutes, Centers, and Offices involved in an NIH-wide initiative to study the social, behavioral, and economic impacts of COVID-19 . The initiative emphasizes research with populations who experience health disparities and other vulnerable populations (e.g., populations who experience mental health and substance use problems, essential workers).
Dr. Borja reviewed various FOAs and NOSIs related to COVID-19 and mental health, including the NOSI on School Disruptions and the Impact of Mental Health, Cognitive, Social, and Emotional Development of Children (NOT-MH-21-225 ) and the NOSI on the Social, Behavioral, and Economic (SBE) Impact of COVID-19 in Underserved and Vulnerable Populations (NOT-MH-21-330 ).
Discussion
Dr. Gordon said that part of the SBE Initiative is focused on understanding regional heterogeneity in the application of and adherence to mitigation measures and the consequent effects on health, economics, and wellbeing. NIH’s role is to identify and share evidence for the efficacy of mitigation and public health measures, such as masking in schools and closure of recreational spaces.
Dr. Borja stated that communication is a key component of public health success, and there is a need for a wide range of strategies and approaches to improve uptake of health behaviors in vulnerable communities. Dr. Vinogradov noted the importance of studying the cognitive factors that render an individual vulnerable to misinformation.
Amy Kilbourn, Ph.D. said that the Department of Veterans Affairs has conducted a study on vaccine hesitancy that reflects national trends in the civilian population.
Kamilah Jackson, M.D. noted opportunities to bolster the mental health workforce and increase workforce diversity, pointing out that a diverse workforce may be better equipped to engage vulnerable racial/ethnic minority populations. Dr. Gordon mentioned that NIH is overseeing an initiative called NIH Community Engagement Alliance (CEAL ), which has made large investments in minority-serving and community-based institutions to study vaccine hesitancy in minority communities.
V. Concept Clearances
A. Addressing Mental Health Disparities Research Gaps: Aggregating and Mining Existing Datasets for Secondary Analyses, Eve Reider, Ph.D.
Dr. Eve Reider proposed a concept to encourage research on the underlying mechanisms of health disparities to inform risk and etiology, prevention and treatment interventions, and services interventions. Other interest areas include modifiable risk, protective factors, and service delivery. The intention of this concept is to encourage research that will ultimately increase health equity, particularly as it relates to examination of subgroups and low base-rate behaviors.
Discussion
Discussants: Dr. Telfair, Dr. Jackson
Dr. Jackson supported the concept and suggested adding an intersectionality component and amplifying opportunities for early intervention and prevention. Dr. Telfair agreed and added that people with physical disabilities and hidden disabilities (e.g., genetic disorders) are a key population to consider in pursuit of health equity.
Anita Everett, M.D. noted that reduced health-seeking behavior among vulnerable populations may affect data capture from electronic medical records. She recommended consideration of community data matched with health care data to address differences in health-seeking behaviors that may bias available datasets.
Dr. Gordon called for a motion to approve the concept. A motion to approve was passed.
B. Neuron-Glia Computations Governing Complex Behaviors, Michele Ferrante, Ph.D.
Dr. Michele Ferrante presented a concept for research testing mechanistic hypotheses on the role of neuron-glial activity in mental health behaviors such as working memory, emotion regulation, social processes, and executive function. NIMH seeks research that will provide novel insights into neuron-glia dynamic interactions during behavior, computational strategies that account for neuron-glia coupling, and experimental validations of hypotheses with neurotechnology.
Discussion
Discussants: Dr. Niv, Dr. Zeng
Dr. Niv suggested that the concept include learning as a focus area to expand beyond short-term working memory. Hongkui Zeng, Ph.D. expressed strong support for the concept and noted the challenges associated with technology development for in vivo monitoring and manipulation of glial cells given their unique cell biology.
Dr. Gordon called for a motion to approve the concept. A motion to approve was passed.
C. NIMH Biobehavioral Research Awards for Innovative New Scientists (NIMH BRAINS), Eric Murphy, Ph.D. (Reissue)
Dr. Eric Murphy presented an initiative to continue a flagship program encouraging early-stage investigators to pursue transformative, high-risk, high-reward projects that directly address NIMH strategic plan priorities. While early-stage investigators may have radically transformative ideas, they often are implicitly or explicitly encouraged to pursue less ambitious projects. The NIMH BRAINS program aims to allow early-stage investigators to perform ambitious and transformative research early in their careers with the hopes of speeding the trajectory of their research careers.
Discussion
Discussants: Dr. Goldstein, Dr. Niv
Dr. David Goldstein and Dr. Niv expressed strong support for the concept. Dr. Niv added that calls for people described as “exceptional” tend to draw more men than women, but this mechanism has maintained an impressive gender balance.
Mr. Staglin wholeheartedly supported the concept and mentioned several nonprofits that offer similar awards. He recommended that NIMH coordinate with other nonprofits to enhance funding continuity for early-stage investigators.
Dr. Gordon called for a motion to approve the concept. A motion to approve was passed.
D. Post-Acute Interventions to Optimize Long-Term Mental Health Outcomes in Low- and Middle-Income Counties, Leonardo Cubillos, M.D., M.P.H.
Dr. Leonardo Cubillos proposed a concept to support implementation research to improve the quality, availability, and accessibility of post-acute mental health services in low- and middle-income countries (LMICs). Despite evidence that post-acute interventions are effective in LMICs, many of these countries have scant to no services beyond acute inpatient care, and most mental health expenditures go to psychiatric hospitals, leaving little for community or outpatient services.
Discussion
Discussants: Dr. King, Dr. Telfair
Dr. King supported the concept and suggested emphasizing scalability, fidelity, and sustainability of technological advances in mental health services. Dr. Telfair agreed and recommended that the work should use an equity lens, perhaps by a train-the-trainer intervention. He also pointed out that interventions likely will require on-the-ground adjustments to best fit the social and cultural contexts at hand. Last, he encouraged Dr. Cubillos to consider incorporating a cross-training approach and an assessment component.
Dr. Gordon called for a motion to approve the concept. A motion to approve was passed.
E. Integrating Mental Health Care Into Health Care Systems in Low- and Middle-Income Countries, Andrea Horvath Marques, M.D., M.P.H., Ph.D.
Dr. Andrea Horvath Marques presented a concept to support research to develop, optimize, and test innovative strategies for implementing, scaling up, and sustaining integrated mental health care models in LMICs and low-resource settings. It would leverage existing platforms of care to identify the necessary core elements of mental health care to integrate in primary care settings. The ultimate goal is to improve health and mental health outcomes at the system, organization, family, and patient levels.
Discussion
Discussants: Dr. Kilbourne, Dr. King
Both discussants supported the concept. Dr. King suggested that the project could be expanded through incentives for capacity building and informatics infrastructures. She also noted the importance of task shifting, policy change, and virtual care across settings.
Dr. Kilbourne emphasized the importance of involving local mental health experts to support care coordination and sustainability. She pointed out that an effective strategy should prioritize targeting of multiple conditions given the high prevalence of co-occurring health conditions with mental disorders.
Dr. Everett suggested more broadly characterizing the role of interventions rather than implementing narrow, single-shot interventions.
Dr. Telfair pointed out several challenges to implementing such a project. In LMIC settings, and in concomitant areas in the U.S., mental health services frequently are outsourced. As a result, he asked Dr. Horvath Marques to consider integrating with community-based organizations (CBOs) and non-governmental organization (NGOs).
Dr. Gordon called for a motion to approve the concept. A motion to approve was passed.
F. Mental Health Research Dissertation Grant to Enhance Workforce Diversity, Mark Chavez, Ph.D. (Reissue)
Dr. Mark Chavez proposed an initiative to continue enhancing NIMH research workforce diversity by supporting mental health-related dissertation-phase research through support targeted at the later stages of doctoral training.
Discussion
Discussants: Dr. Almasy, Dr. Kilbourne
Dr. Laura Almasy expressed support for the concept and reiterated the value of a diverse workforce.
Dr. Kilbourne was also supportive. She said there is a need to extend these efforts to the undergraduate and high school settings.
Dr. Gordon said that the last five years have seen a substantial increase in the quality and scores of these supplement applications, which he attributed to the NIMH Office of Disparities Research and Workforce Diversity.
Dr. Gordon called for a motion to approve the concept. A motion to approve was passed.
Abbreviated Concept Clearances
G. BRAIN Initiative: Brain-Behavior Quantification and Synchronization, Sarah H. Lisanby, M.D.
Dr. Sarah Lisanby presented a concept to develop high-resolution tools and platforms to precisely quantify behaviors as a multi-dimensional response and synchronize them with recorded brain activity; to build new conceptual and computation models of behavioral systems; and to establish a cross-disciplinary consortium to develop and disseminate new tools, ontologies, research designs, and ethical frameworks. The ultimate intent is to develop new technologies to understand how the brain generates behavior and to establish causal relationships between behavior and circuit activity.
Discussion
Discussant: Mr. Staglin
Mr. Staglin expressed full support for the concept. He asked if the consortium would consult with groups like the International Neuroethics Society. In terms of human subject recruitment, he strongly recommended ensuring a racially and ethnically diverse cohort of subjects. Dr. Lisanby confirmed that they plan to engage the ethics community from the outset. Additionally, they intend to ensure diversity both in the study cohort and among the participating investigators.
Dr. Gordon called for a motion to approve the concept. A motion to approve was passed.
VI. Adjournment
Dr. Gordon invited Council members to submit any additional comments or questions regarding the concept clearances. The open session of the meeting adjourned at 4:05 pm.
CLOSED PORTION OF THE MEETING
The grant application review portion of the meeting was closed to the public in accordance with provisions as set forth in Section 552b(c)(4) and 552b(c)6. Title 5, U.S. Code and Section 10(d) of the Federal Advisory Committee Act, as amended (5 U.S.C. Appendix 2).
Members absented themselves from the meeting during discussion of and voting on applications from their own institutions, or other applications in which there was a potential conflict of interest, real or apparent. Members were asked to sign a statement to this effect.
VII. Review of Applications
Refer to Appendix A.
VIII. Adjournment
Dr. Gordon thanked the Council members. The closed session of the NAMHC meeting adjourned at 3:30 p.m. on September 15, 2021.
_____________________________
Joshua Gordon, M.D., Ph.D.
Chair Person
National Advisory Council On Mental Health
Tracy Waldeck, Ph.D.
Executive Secretary
National Advisory Council on Mental Health
Department of Health and Human Services
Public Health Service
National Institutes of Health
National Advisory Mental Health Council
Summary of 265th Meeting, September 14 & 15, 2021
Staff Present Virtually:
|
Taameem Almaliki |
Jovier Evans |
Douglas Kim |
Others Present Virtually:
Diana Worthen, Transcriber
Marie Rowland, Science Writer
Candice Martin, Captioner
Appendix A
Summary of Primary MH Applications Reviewed
Council: October 2021
| IRG Recommendation | ||||||||
|---|---|---|---|---|---|---|---|---|
| Category | Scored # | Scored Direct Cost $ | Not Scored (NRFC) # | Not Scored (NRFC) Direct Cost $ | Other # | Other Direct Cost $ | Total # | Total Direct Cost $ |
| Research | 660 | $1,012,077,113 | 491 | $625,381,592 | 4 | 5,739,597 | 1155 | $1,643,198,302 |
| Research Training | 0 | 0 | 0 | |||||
| Career | 68 | $57,513,926 | 32 | $26,556,485 | 0 | 0 | 100 | $84,070,411 |
| Other | 0 | 0 | 0 | 0 | 0 | |||
| Totals | 728 | $1,069,591,039 | 523 | $651,938,077 | 4 | $5,739,597 | 1255 | $1,727,268,713 |
Appendix B
Department of Health and Human Services
National Institutes of Health
National Institutes of Mental Health
National Advisory Mental Health Council
(Terms end 9/30 of designated year)
Chairperson
- Joshua A. Gordon, M.D., Ph.D.
Director
National Institute of Mental Health
Bethesda, MD
Executive Secretary
- Tracy Waldeck, Ph.D.
Director
Division of Extramural Activities
National Institute of Mental Health
Bethesda, MD
Members
- Laura A. Almasy, Ph.D. (22)
Professor
Department of Genetics
Perelman School of Medicine
University of Pennsylvania
Philadelphia, PA - Marjorie L. Baldwin, Ph.D. (22)
Professor
Department of Economics
W.P. Carey School of Business
Arizona State University
Tempe, AZ - David Goldstein, Ph.D. (23)
Director
Institute for Genetic Medicine
Columbia University
Hammer Building
New York, NY - Kamilah Jackson, M. D. (23)
Medical Director
PerformCare
Robbinsville, NJ - Cheryl A. King, Ph.D. (21)
Professor and Director
Youth and Young Adult Suicide Prevention Program
Department of Psychiatry
University of Michigan
Rachel Upjohn Building
Ann Arbor, MI - Yael Niv, Ph.D. (21)
Professor
Princeton Neuroscience Institute
Department of Psychology
Princeton University
Princeton, NJ - Neil J. Risch, Ph.D. (21)
Professor, Epidemiology and Biostatistics
Lamond Family Foundation Distinguished Professor in Human Genetics
University of California, San Francisco
San Francisco, CA - Brandon Staglin, M.S. (21)
President
One Mind Institute
Rutherford, CA - Joseph Telfair, DrPH, MPH, (23)
Professor and Associate Dean
for Public Health Practice and Research
Karl E. Peace Distinguished Chair of Public Health
Fellow, Royal Society of Public Health
Jiann-Ping Hsu College of Public Health
Georgia Southern University
Statesboro, GA - Sophia Vinogradov, M.D. (22)
Donald W. Hastings Endowed Chair
University of Minnesota Medical School
Professor and Department Head
Department of Psychiatry
Minneapolis, MN - Hongkui Zeng, Ph.D., (23)
Executive Vice President and Director
Allen Institute for Brain Science
Seattle, WA
Ex Officio Members
Office of the Secretary, DHHS
Xavier Becerra
Secretary
Department of Health and Human Services
Washington, DC
National Institutes of Health
Francis Collins, M.D., Ph.D.
Director
National Institutes of Health
Bethesda, MD
Department of Veterans Affairs
Amy M. Kilbourne, Ph.D., M.P.H.
Director, Quality Enhancement Research Initiative(QUERI)
U.S. Department of Veterans Affairs
Professor of Learning Health Sciences
University of Michigan Medical School
Ann Arbor, MI
Department of Defense
Liaison Representative
Anita Everett, M.D., DFAPA
Director
Center for Mental Health Services
US, HHS Substance Abuse and Mental Health Services
Rockville, MD