Commencement

It is often said, perhaps to the point of cliché, that the end of one chapter is the beginning of another; hence, a graduation ceremony is labeled a “commencement.” I’ve had several commencement ceremonies of my own, and, at the time, I very much felt that notion of them being a beginning.

Graduating high school, I looked forward to college, expanding my horizons and deepening my knowledge base. Graduating college, I looked forward to medical and graduate schools, embarking on my final stages of training, and focusing on psychiatry and research. Finally, graduating from my residency, I looked forward to proving myself all over again as a scientist, educator, and clinician—and to being done with commencements. Yet, here I am, over 20 years later, facing another ending that is also a beginning. This is my last message as Director of NIMH. On June 14, I will leave this incredible place and begin again.

Accordingly, I think back to my last beginning, when I arrived at NIMH in the fall of 2016. In my first Director’s Message, titled “Freshman Year,” I wrote of my anxiety and uncertainty, hope and excitement, and desire to listen and learn. I also wrote of my commitment to excellent science, diversity, and priority science areas like suicide prevention, computational psychiatry, and circuit neuroscience. I have spent my time since then working diligently alongside my fellow NIMHers to fulfill these commitments and address these priorities. I’m proud of what we’ve accomplished together.

Excellent science

Supporting excellent science has always been the first and foremost priority for NIMH. For the most part, this is a straightforward task. Our intramural scientists are an outstanding group, conducting cutting-edge research in basic and clinical neuroscience. NIMH scientists have documented the ability of ketamine to rapidly reduce suicidal thoughts , explored the microcircuitry underlying anxiety-related defensive behaviors , studied risk factors for increased anxiety in children in the context of the COVID-19 pandemic, and so much more.

On the extramural side, with the help of scientists and community members, NIMH staff have worked diligently to create policies and advance priorities that promote excellence in the science we fund. Over the past 8 years, this has included clarifying how genomic evidence should be used to justify biological studies  of the causes of mental illnesses, describing optimal approaches for studying the influence of stress  on the brain and the risk for mental illnesses, and detailing best practices in the design and interpretation of studies that use model organisms  to examine the neurobiology of mental illnesses.

Diversity

A second guiding principle behind NIMH’s support of mental health research is that we seek to support a diversity of science. I have noted that diversity in research involves many factors, including the time frame for the public health impact of the research and the involvement of people conducting and participating in the research. NIMH has worked diligently under my tenure to ensure that our portfolio is diverse in each of these ways.

A key part of our efforts in funding diverse science has been transparency. By analyzing and sharing our funding priorities and research portfolio, it became clear to us—and to many in the research community—that NIMH-funded research aimed at short-term public health impact had been declining for some time. This critically important component of the NIMH portfolio includes research aimed at developing and testing new treatments, improving existing treatments, and expanding the delivery of mental health services to ensure treatments are available to all who need them. To reverse this trend, we worked across NIMH, but especially with the Division of Services and Intervention Research, to clarify our interests in such research and encourage high-quality applications. Through dedicated outreach, we have successfully reversed this trend and restored support levels for near-term research while still ensuring we fund only the best science.

To support the best science in our portfolio, we must make sure the very best scientists are empowered to carry out this research. To encourage the inclusion of a diverse scientific workforce, we must make sure our processes are equitable and open to all. This has been a particular focus of our efforts at NIMH, both within the institute and in the extramural workforce whose projects we support. Inside NIMH, we have made significant strides to ensure our recruitment, retention, and promotion policies are equitable and to make sure our workplace culture is welcoming and inclusive. Extramurally, we have revamped our grant application processes at every level to ensure equity and take into consideration a variety of scientific perspectives. One concrete result of this work: Black principal investigators used to have a lower grant application success rate than White principal investigators, but we eliminated that gap .

Scientific priorities

During my first year as Director, I learned about gaps and opportunities in our portfolio and pressing public health needs. Based on what I learned, I chose three specific scientific priority areas: suicide prevention, computational psychiatry, and circuit neuroscience. I’m pleased to say that during my time at NIMH, we’ve made progress in each of these three areas.

In the area of suicide prevention, NIMH’s intramural researchers, for example, have developed and tested a simple four-question suicide risk screener that works in a variety of populations, including young children. NIMH’s extramural staff have also been working hard, supporting multiple calls for applications using innovative mechanisms like the new Practice-Based Suicide Prevention Research Centers. We’ve also funded a suite of studies asking whether and how rapid-acting medications like ketamine can reduce suicidal behaviors and deaths in real-world clinical practice settings. In fact, we’re funding so many outstanding studies in this area that our suicide prevention research portfolio has tripled in size in the past 7 years. This support has led to impactful findings, such as research that established the utility of universal screening for suicide in various health care settings and demonstrated how to implement and maintain screening practices successfully.

Computational psychiatry is a term used to describe the application of a broad range of theoretical and mathematical approaches to mental health research. Accordingly, our efforts to support such research have been multifaceted. In basic neuroscience, NIMH supports the Collaborative Research in Computational Neuroscience (CRCNS)  program, which advances research aimed at modeling basic neurobiological processes, seeking to uncover the rules by which the cells, circuits, and systems of the brain operate. At the level of behavior, we have encouraged the development of tasks that characterize cognitive and emotional function  in mathematical terms and the application of these theoretical models to understanding symptoms of mental illnesses such as suicidal thoughts and behaviors  and anhedonia. And most recently, we’ve launched a series of initiatives aimed at using big data, machine learning, and predictive analytics to better understand the heterogeneity of mental illnesses and develop biomarkers  to help patients and their doctors make informed treatment decisions.

Last but not least, NIMH has spearheaded advancements in circuit neuroscience that seek to lay a foundation of knowledge to transform our understanding of the brain mechanisms of mental illnesses. The Brain Research Through Advancing Innovative Neurotechnologies® Initiative, or The BRAIN Initiative® , which NIMH co-leads along with the National Institute of Neurological Disorders and Stroke , has developed novel tools, technologies, and resources to describe the many cell types of the brain, how those cell types are arranged and interconnected, and how they function to produce complex behaviors. NIMH has also supported efforts like PsychENCODE , which seek to define the molecular mechanisms that underly genetic risk for mental illnesses. Recently, the results of the second phase of PsychENCODE were published in an extensive series of papers  that detail the biological pathways, cell types, and developmental time windows identified by these crucial studies, paving the way for novel treatment discovery efforts.

Commencement

These many accomplishments occurred during a period of astounding growth and success for NIMH, a period that it has been my privilege and honor to experience first-hand. In addition to these successes, we’ve witnessed the U.S. Food and Drug Administration  approve novel antidepressant medications: the first-ever medication for treating postpartum depression  and a rapid-acting, first-of-its-kind nasal spray for treatment-resistant depression , both the result of decades of NIMH investments in neurobiology and pharmacology research. Meanwhile, NIMH-funded psychotherapy research informed a recommendation by the United States Preventative Services Task Force for the use of psychotherapy to help prevent perinatal depression . NIMH-supported research on early psychosis care resulted in federal funding for over 350 clinics delivering evidence-based coordinated specialty care around the United States, a remarkable transformation in public mental health care that has improved outcomes for tens of thousands of Americans experiencing their first episode of psychosis.

These important public health achievements relied on research conducted long before I got to NIMH, demonstrating the key role that past research investments have played in improving the present lives of those living with mental illnesses. Research pays off in terms of impact on mental health care; I look forward to the future when I can see the impact of NIMH research conducted and supported during my tenure.

As much as I’ve enjoyed this front-seat view of mental health history, I’ve come to realize that I’ve done what I set out to do when I came to NIMH my freshman year. It’s time to give someone else a chance, someone with a new set of bright ideas. So, I say farewell to NIMH, knowing that its future is bright. And I head off to start a new chapter of my career. I hope to use what I’ve learned at NIMH to continue to support impactful research, policy, and practices in mental health for years to come.