On behalf of the Consortium of Social Science Associations (COSSA), we write to communicate our strong disagreement with the recently reported assertion that the National Institute of Mental Health (NIMH) is failing in "its primary mission." COSSA is an advocacy organization on behalf of 110 professional associations, scientific societies, universities, and research institutions. A roster of our members is attached.
These news reports are based on a report prepared by the National Alliance for the Mentally Ill (NAMI). This report seriously misrepresents the mission of NIMH. Most important, the report leaves out the fact that the mission of the NIMH, as legislatively mandated as part of the National Institutes of Health, in the ADAMHA Reorganization Act (Public Law 102 - 321 ) is:
". . . the conduct and support of biomedical and behavioral research, health services research, research training, and health information dissemination with respect to the cause, diagnosis, treatment, control and prevention of mental illness . . . [and] shall be designed to further treatment and prevention of mental illness, the promotion of mental health and the study of psychological, social, and legal factors that influence behavior."
Without the broad research portfolio of the National Institute of Mental Health, we would not know that:
More than 19 million adult Americans age 18 and older will suffer from a depressive illness major depression, bipolar disorder, or dysthymia each year. Depression is a frequent and serious complication of heart attack, stroke, diabetes, and cancer. Depression costs the nation more than $30 billion per year in direct and indirect costs, according to the most recent data available. Major depression is the leading cause of disability in the United States and worldwide, according to a recent study by the World Health Organization, the World Bank, and Harvard University.
More than 16 million adults, ages 18 to 54, suffer from anxiety disorders (panic disorder, post- traumatic stress disorder, social phobia and generalized anxiety disorder). Anxiety disorders are frequently complicated by depression, eating disorders, or substance abuse. Many people have more than one anxiety disorder. In 1990, anxiety disorders cost the U.S. $46.6 billion. Approximately 31,000 people died of suicide in 1996 (the year the most recent statistics are available) in the United States. It is the third leading cause of death among 15 to 24 year olds. Men are more than four times as likely as women to commit suicide.
Approximately 5.3 million ( 3.7 percent) American adults, have social phobia in a given year. Social phobia begins in childhood or early adolescence and is often accompanied by depression and may lead to alcohol or other drug abuse.
Attention deficit hyperactivity disorder (ADHD) is one of the most common mental disorders in children, affecting three to five percent of school-aged children. Boys are affected two to three times more often than girls. ADHD adversely affects success at school, work, and social relationships. As they grow older, children with untreated ADHD who have a coexisting conduct disorder often experience drug abuse, antisocial behavior, teenage pregnancy, and injuries of all sorts.
The National Institute of Mental Health, as mandated by its mission, supports basic, clinical, and epidemiological research on the behavioral, biological, genetic and social factors and psychological processes and mechanisms that underlie mental illness and that has an impact on physical health and the maintenance of emotional well-being. COSSA strongly believes that if NIMH's research portfolio was limited only to "severe mental illness," as suggested by NAMI's report, scientific progress to understand, prevent and treat other mental disorders would be seriously and immeasurably compromised. These would include: the most common forms of depression, anxiety disorders, panic disorder, post-traumatic stress disorder, social phobia, attention deficit hyperactivity disorder, autism, eating disorders as well as other mental disorders. Likewise, limiting NIMH's mission to research only on severe mental illness, would impede the progress that has been made in understanding and treating other mental disorders such as depression in the elderly; youth violence and suicide; child abuse and neglect; eating disorders; post-traumatic stress disorders; attention deficit-hyperactivity disorder; and many other mental disorders.
We cannot afford, through the lack of support for research into those less than severe mental disorders, to arrest the current scientific momentum and progress NIMH's research has provided our nation toward alleviating and lessening the barriers to good mental health, as well as enhancing the quality of life for those affected with mental disorders.
COSSA also firmly believes that NIMH's continued support of both basic and applied research is critical to the mission of the agency, especially research that seeks to identify the key aspects that may threaten or protect mental health and well-being. Despite NAMI's assertion to the contrary, NIMH has funded basic research in these areas since its inception. In fact, "NIMH's first research grant in 1947 was awarded for a behavioral and neurological study of the learning process."
There remains a critical need for basic social, behavioral, and cultural research that can help us solve many pressing public health and social welfare problems. For example, knowing how social processes influence attitudes and behaviors in different cultural groups can strengthen efforts to prevent AIDS and substance abuse. Likewise, discovering whether existing research findings on the parent-child-school relationship are relevant to homeless parents and children can help us respond better to their social and educational needs. In addition, research that examines human resilience factors hope, optimism, courage, and the capacity for future mindedness may serve as buffers against depression and other mental disorders and, therefore, should be continued.
An abundance of epidemiologic research has established that mental disorders and other medical conditions, including HIV disease, are frequently comorbid. This same data shows that sometimes these diseases co-occur and have equally devastating impact on individuals. Accordingly, a 1995 National Advisory Mental Health Council report to the NIMH noted that "the growth of scientific knowledge about basic cognitive and motivational mechanisms, emotional and personality development, and interpersonal, family, and cultural factors have profoundly changed our understanding of normal and abnormal behavior." Some of society's most recalcitrant health problems will never be solved without an investment in understanding the mechanisms that link behavioral and psychosocial factors to health and exploiting the knowledge necessary to develop interventions that will ease public suffering and improve health. It is incumbent that NIMH continue to fund, as well as increase its investment in research on the intersection of social/behavioral factors and physical diseases.
The report criticizes NIMH's support of AIDS research. COSSA strongly agrees with NIMH Director Steven Hyman's assessment that the report is "disingenuous" in its discussion of the Institute's support of research on HIV/AIDS. Without question, NIMH-supported research on HIV/AIDS fits within the intended congressional mission for the Institute. NIMH's support of research in this area has improved our understanding of perceptions of risk, resilience to risk, self-efficacy and health promoting behaviors. Additionally, NIMH-supported HIV/AIDS research has further improved our understanding of interventions for combating the risky sexual behavior of the mentally ill many of whom could be considered constituents of NAMI.
While COSSA understands the sense of urgency in finding a cure for severe mental illness, we must be careful not to ignore the breadth and forms of mental illness, the need for knowledge that can promote mental health and the serendipitous nature of research. To do so would result in the endorsing of a limited and short- sighted research strategy. COSSA urges your continued support of a balanced program of grant funding in mental health and mental illness, including basic and applied behavioral, social and neuroscience research at the National Institute of Mental Health.
Howard J. Silver, Ph.D., Executive Director, COSSA
Felice J. Levine, Ph.D. Chair, COSSA Executive Committee Executive Officer, American Sociological Association
cc: Steven Hyman, M.D., Director National Institute of Mental Health