Hope insufficient: science to services is required in crisis

Nation’s Chief Psychiatrist, Dr. Thomas Insel, Defines Mental Health Treatment Challenge In Best Of Times And Worst Of Times: The Genomic Era Of Hope Against A System Failing In Treatment Delivery.

Jul 01 2003

Minneapolis, MN - "Basic research represents hope," Dr. Thomas Insel, director of the National Institute on Mental Health (NIMH), Bethesda, MD, said to well over 2000 attendees during the Research Plenary at the NAMI Annual Convention Tuesday, Minneapolis, MN. "But hope is not enough when we are in crisis in our communities as indicated by this conference."

"Much of mental health care is no longer in the mental health care system," he continued. "It’s in jails, nursing homes, schools, primary care offices – not where it belongs." Calling himself the new kid on the block learning during this his first year as head of NIMH, Insel cited three Fs in grading America’s treatment of people with serious mental illness:

  • Fragmentation in a mental health service delivery system in shambles;
  • Failure of access to effective treatments due to phantom networks, restrictions in care and financial barriers, such as lack of insurance; and
  • Fallibility of poor services being delivered, rather than effective, evidence-based practices.

"We must align it as an urgent public health problem; people not even in the system," he said.

Followed by four top national scientists, Insel outlined the NIMH vision of scientific rigor and relevance in real time, "Science informs practice. We must assure that what we know is what we do."

Dr. Ed Scolnick, president emeritus, Merck Research Laboratories, West Point, PA, shared revealing data comparing mental illness research with other prominent areas of medical research, such as atherosclerosis. He charted other fields of scientific research and demonstrated the logical lines of design, process and outcomes. With mental illness research most pharmacological treatments now available, he said, were sourced from "very lucky" discoveries observed during research on entirely unrelated work. "This, in science, is an anachronism," Scolnick said, "We need a new paradigm to drive mental illness research."

Agreeing with Insel, Scolnick said the recent cracking of the human genome, is the hope of success for diseases like schizophrenia, about which science has discovered so little.

Wayne Fenton, M.D., associate director of clinical affairs, NIMH, spoke on upcoming clinical trials and research on new therapeutic interventions related to cognition in defining and treating serious mental illnesses. Raquel Gur, M.D., professor of psychology, University of Pennsylvania, Philadelphia, PA, expanded on the cognition research focus, discussing genetic traits, susceptibilities and risks in developing serious mental illnesses. She highlighted former thinking, which was purely discrete: either you do or you don’t have mental illness. New work, she said, is demonstrating that a continuous liability exists. She stated that factors in multipliers such as, genetic proclivity, environmental effects and events, may collectively take any susceptible individual "across the line" into illness when combined. Gur said NIMH plans large scale, multi-site family studies and clinical work to promote early identification and intervention based on these premises.

The session ended with Dr. Husseini Manji, chief Laboratory of Molecular Pathophysiology, NIMH explaining advances in physiological brain functioning. Exciting new genome explorations, he stated, may indicate that treatments like the current medications for depression and other serious mental illnesses targeting the synaptic brain processes, where cells "talk" with each other, are only surface mechanisms. These surface manipulators may actually be turning on the switch to an information super highway that genetic studies are just beginning to map.