# Message from the Director

It is an exciting time to be at the helm of the National Institute of Mental Health (NIMH), the lead federal agency charged with setting and supporting the national agenda for mental health research. Scientific advances are rapidly transforming neuroscience and mental health care. Just in the last five years, we have made considerable progress. In basic science, the genetic revolution has begun to pay off for mental health research—after facing some challenges, we have now identified hundreds of places in the genome irrefutably linked to mental illnesses such as schizophrenia, autism, and depression. Thanks to the NIH *Brain Research through Advancing Innovative Neurotechnologies*® (BRAIN) Initiative **, we have new tools and resources that allow unprecedented insight into the exquisite complexities of the living brain. In translational sciences, we celebrated the U.S. Food and Drug Administration (FDA) approval of two of the first truly novel antidepressants in decades—esketamine for treatment-resistant depression, and brexanolone for postpartum depression. And in intervention research, NIMH-sponsored studies proving the effectiveness of coordinated specialty care for first episode psychosis led to nationwide implementation of this evidence-based care model through state-supported mental health clinics.

The future is bright. We’ve enacted the NIMH Strategic Plan for Research, aiming to build on these advances. Over the next few years, we look forward to further implementation of suicide prevention efforts based on recent NIMH findings. These findings include studies demonstrating the benefit of universal screening in emergency departments for suicidal thoughts and behaviors, and the benefits and challenges of predicting suicide risk using electronic health records and other digital tools. NIMH is also investing in practice-based research that examines mental health care delivery in real-world settings. For example, NIMH is pioneering the Early Psychosis Intervention Network (EPINET), a research network that will use data from community-based first episode psychosis clinics to enhance the delivery, evaluation, and continual improvement of evidence-based care. These continuous advances drive the enthusiastic and energetic efforts of the research workforce devoted to our mission. And, more importantly, they offer hope and solutions to individuals with mental illnesses, as well as their families and communities.

Since the advent of this plan in 2020, we have faced significant challenges. Early in the coronavirus disease 2019 (COVID-19) pandemic, symptoms of depression, anxiety, and substance use increased for many, and although those symptoms resolved for most, some continue to have elevated symptoms. At the same time, minoritized and marginalized communities were disproportionately impacted by greater rates of illness and death tragically due to SARS-CoV-2 infection as well as with broader mental health consequences of the social, behavioral, and economic impacts of the pandemic. Those infected with SARS-CoV-2 can also experience an increase in new mental illness both in the short- and long-term. Regardless of direct infection, reports suggest mental health symptoms have remained elevated compared to pre-pandemic data. Groups differentially impacted by COVID-19, including Black, Latinx, American Indian/Alaska Native, LGBTQ+, and other minoritized and marginalized communities, continue to experience greater challenges.

NIMH has relied on its strategic plan to adapt to these challenges. We continue to collaborate with other institutes, centers, and offices across NIH, funding more than 40 projects to understand the mental health impacts of the pandemic, including the impact of public health mitigation approaches, and critically to evaluate scalable, deployable interventions that are desperately needed to respond to the increased mental health needs of diverse populations. All of these efforts are in line with our strategic priorities, particularly in the context of ongoing mental health disparities.

As NIMH Director, I am committed to dismantling structural racism in biomedical research. At NIMH, we aim to identify and address the extent to which our policies, practices, and culture serve to perpetuate the status quo and are working to promote anti-racist ideas and actions both within NIMH and in the research communities we support. We started by examining how our application review process affects the diversity of our scientific workforce. For example, some of our early efforts are focused on understanding and employing solutions to reduce disparities in award rates for grant applications supporting Black investigators. We are also making changes to improve diversity, equity, inclusion, and accessibility (DEIA) within the NIMH workplace. In response to an internal assessment, NIMH is creating new opportunities for dialogue, training, and engagement to advance DEIA efforts. I recognize that these efforts, among others in alignment with the NIH-Wide Strategic Plan for DEIA ** and the UNITE initiative **, are just the start to making lasting change.

The NIMH Strategic Plan for Research maps our path. From basic research aimed at understanding how the brain produces behavior, to translational efforts to uncover novel treatment targets, to clinical studies testing novel approaches in community settings, we have charted numerous routes linking these challenges and opportunities. Each has the potential to deliver significant advances in mental health care. NIMH’s broad portfolio aims to ensure that our research will have public health impacts across a range of timeframes—from the near-term to the far-off future. At NIMH, we are proud of how far we have come, humbled by the distance yet to be traveled, and empowered by the hope that drives us forward.

 

Joshua A. Gordon, M.D., Ph.D.Director, National Institute of Mental Health

Updated: May 2023