Thomas R. Insel M.D.
National Institute of Mental Health
National Institutes of Health
Department of Health and Human Services
Mind, Brain, and Behavior
Committee on Appropriations
Subcommittee on Labor, Health and Human Services, Education and Related Agencies
Monday March 26, 2007
Mr. Chairman, and members of the Committee:
I am pleased to present the Fiscal Year (FY) 2008 President’s budget request for the National Institute of Mental Health (NIMH). The FY 2008 budget includes $1,405,421,000. In my statement, I will call to your attention our Nation’s most prevalent mental and behavioral disorders and include a brief review of our research activities and accomplishments.
MENTAL DISORDERS ARE CHRONIC BRAIN DISORDERS
The NIMH mission is to reduce the burden of mental and behavioral disorders, such as depression, schizophrenia, autism, and bipolar disorder, through research on mind, brain, and behavior. Research is demonstrating that these illnesses are brain disorders, accessible by the tools of modern neuroscience. These disorders frequently begin in childhood and are chronic, affecting people of all races and ethnicities, in both rural and urban settings. To prevent a lifetime of disability for millions of Americans, NIMH research is identifying the biological basis of mental disorders, and pinpointing targets for diagnosis, prevention, and treatment.
PUBLIC HEALTH BURDEN OF MENTAL ILLNESS
In the most recent national household survey, as many as 44 million Americans met criteria for some mental disorder, with roughly 12 million reporting symptoms so severe as to cause significant disability in the past year. According to the World Health Organization, mental disorders are also the leading cause of medical disability in the United States and Canada for people ages 15-44. The annual economic cost of mental illness in the U.S. is estimated at well over $150 billion, with most due to the indirect costs of social services. The direct costs of mental health care represent 6.2 percent of the overall health care costs,  which totaled 14.5 percent of the gross domestic product in 2001 according to the Centers for Medicare and Medicaid Services (CMS).
ADVANCING CLINICAL RESEARCH IN MENTAL HEALTH
New tools in genomics, imaging, and behavioral science have given us traction for progress towards reducing this tremendous public health burden. NIMH has adopted the NIH clinical research vision, which focuses on the four P’s of medical research: increasing the capacity to Predict who is at risk for developing disease; developing interventions that Pre-empt the disease process; using knowledge about individual biological, environmental, and social factors to Personalize interventions; and, ensuring that clinical research involves Participation from the diversity of people and settings affected.
The Institute’s focus on practical, or “effectiveness,” clinical trials embodies this research vision. Although traditional clinical trials are useful in determining if groups of patients respond to a treatment, NIMH’s practical clinical trials, conducted with 10,000 patients at 200 sites across the nation, have helped us to understand individual responses to treatment. DNA collected from participants in one such trial, the Sequenced Treatment Alternatives to Relieve Depression (STAR*D), led to the discovery of genetic variations associated with response to antidepressants. Through the inclusion of a diverse population, this research also found that the genetic variation that predicted a favorable response was less commonly found in African-Americans. This pharmacogenomic approach can transform the treatment of mental disorders, allowing clinicians to personalize therapy choices based on a patient’s unique biology.
Results from these practical trials and related studies have taught us that current medications are helpful but not sufficient for most people with schizophrenia, depression, and bipolar disorder. While research on non-drug therapies is showing impressive results in treating a variety of mental illnesses, we clearly need a new generation of medications that are more effective and better tolerated. NIMH research during the past year reported on new classes of antidepressants that work within hours rather than weeks. These findings suggest that we can expect new medications that will transform the treatment of mental illnesses by influencing recently discovered targets in the brain.
New treatments like these antidepressants are based on the emerging science of pathophysiology, the study of how brain structure and functioning are involved in mental disorders. For instance, research on fear has revealed a class of brain receptors and specific brain circuits involved in traumatic memories. Clinical trials with medications that specifically target those receptors and circuits have shown positive effects in reducing stress in response to reminders of trauma and, thereby, offer a new treatment for PTSD. Working with the Department of Defense and the Department of Veterans Affairs, NIMH is supporting research that will treat PTSD and may also prevent the persistence of fearful memories, thus pre-empting the development of PTSD altogether. With 13 percent of returning soldiers diagnosed with PTSD, we recognize the urgent need for safe and effective pre-emptive interventions.
PARTNERSHIPS FOR RESEARCH PROGRESS
NIMH also aims to accelerate research discoveries through collaborative partnerships. Fifteen NIH Institutes invested in research on the nervous system have pooled resources to create the NIH Blueprint for Neuroscience Research, a framework to enhance collaboration in the development of research tools, resources, and training, all of which will be made available to the neuroscience research community. Initiatives will focus on neurodegeneration in 2007, neural development in 2008, and neural plasticity in 2009.
Through public-private partnerships and additional grants coordinated by the Foundation for the National Institutes of Health (FNIH), the Genetic Association Information Network (GAIN) program will investigate the genetic roots of several common diseases and to provide the immediate, broad release of scientific information through a publicly accessible database. Four of the six current GAIN initiatives are related to brain disorders: attention deficit/hyperactivity disorder, schizophrenia, bipolar disorder, and major depressive disorder.
The Biomarkers Consortium is a public-private research partnership of the FNIH that includes NIH, CMS, the Food and Drug Administration, and industry and advocacy organizations to help identify new and valid biomarkers that will advance the creation of innovative technologies and therapies for early detection, diagnosis, and treatment of disease. Some of the first research findings from the Biomarkers consortium and GAIN are expected later in 2007.
These joint initiatives offer translational opportunities for further developing interventions and treatment options that can deliver more effective, personalized care across diverse populations and settings.
In summary, this is a time of unprecedented excitement in mental health research. Neuroscience and genomics are yielding new insights and new treatments, providing great hope for the future. Large-scale, practical trials are helping us optimize the treatments available today. I appreciate this opportunity to tell you about those exciting breakthroughs in the science of mental illness. I look forward to your questions.
Thomas R. Insel, M.D.
Director, National Institute of Mental Health
Thomas R. Insel, M.D., is Director of the National Institute of Mental Health (NIMH), the component of the National Institutes of Health charged with generating the knowledge needed to understand, treat, and prevent mental disorders. Prior to his appointment as Director in 2002, Dr. Insel was Professor of Psychiatry at Emory University. There, he was founding director of the Center for Behavioral Neuroscience, one of the largest science and technology centers funded by the National Science Foundation and, concurrently, director of an NIH-funded Center for Autism Research. From 1994 to 1999, he was Director of the Yerkes Regional Primate Research Center in Atlanta. In addition to these administrative posts, Dr. Insel had a distinguished research career. He was a pioneer in the field of social neuroscience, with classic studies of the neurobiological basis of complex social behaviors in animals. Prior to moving to Emory, Dr. Insel was a scientist in the NIMH intramural program from 1979 to 1994. Early in this period, he conducted clinical research on obsessive-compulsive disorder, completing some of the first treatment trials for OCD using the selective serotonin reuptake inhibitors (SSRI) class of medications. He has published over 200 scientific articles and four books, including The Neurobiology of Parental Care (with Michael Numan) in 2003.
Dr. Insel has served on numerous academic, scientific, and professional committees, including 10 editorial boards. He is a member of the Institute of Medicine, a fellow of the American College of Neuropsychopharmacology, and is a recipient of several awards (A. E. Bennett Award from the Society for Biological Psychiatry, Curt Richter Prize from the International Society of Psychoneuroendocrinology, Outstanding Service Award from the U.S. Public Health Service, and a Distinguished Investigator Award from NARSAD). Dr. Insel graduated from the combined B.A.-M.D. program at Boston University in 1974. He did his internship at Berkshire Medical Center, Pittsfield, Massachusetts, and his residency at the Langley Porter Neuropsychiatric Institute at the University of California, San Francisco.
Department of Health and Human Services
Office of Budget
Richard J. Turman
Mr. Turman is the Deputy Assistant Secretary for Budget, HHS. He joined federal service as a Presidential Management Intern in 1987 at the Office of Management and Budget, where he worked as a Budget Examiner and later as a Branch Chief. He has worked as a Legislative Assistant in the Senate, as the Director of Federal Relations for an association of research universities, and as the Associate Director for Budget of the National Institutes of Health. He received a Bachelor’s Degree from the University of California, Santa Cruz, and a Masters in Public Policy from the University of California, Berkeley.
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Last revised: April 19, 2011