Conference Coverage

NIMH urged to shift priorities toward children’s mental health



ROCKVILLE, MD. – A researcher is calling for a major shift in funding and priorities within the National Institute of Mental Health to seize on ripe opportunities to better understand how social and environmental factors affect the development of children’s brains.

Kimberly E. Hoagwood, PhD, of NYU Langone Health

Dr. Kimberly E. Hoagwood

“This new agenda that I’m suggesting would prioritize child and family health over other populations,” Kimberly E. Hoagwood, PhD, of NYU Langone Health, said at a National Institute of Mental Health conference on mental health services research. “But if we want science to maximize the public health impact and we want our services implementation research to have the biggest impact, then I think we have to think about rebalancing the portfolio.”

Dr. Hoagwood made her argument during a well-received presentation at the meeting. In an interview afterward, Dr. Hoagwood confirmed that she’s advocating for a potential shifting of funds from basic neuroscience.

She previously argued a case for rebalancing priorities within mental health research in a paper published in the Journal of the American Academy of Child and Adolescent Psychiatry (2018 Jan;57[1]:10-3). In the paper, Dr. Hoagwood and her coauthors said the NIMH’s annual funding for child and adolescent services and intervention research decreased 42%, to $30.2 million, from fiscal 2005 to fiscal 2015.

“The NIMH made an explicit decision to invest in basic neuroscience in part because of concerns about the inadequacy of the diagnostic classification systems and limited understanding of the etiology of mental illness,” Dr. Hoagwood and her colleagues wrote in the paper. “This investment could well pay off in the future. However, at least 20% of children now suffer from mental health problems. They cannot be ignored.”

The share of NIMH’s annual budget dedicated to child and adolescent services and intervention research has hovered around 2%-3% in recent years, according to Dr. Hoagwood.

She argued that increased investment in child and adolescent services and intervention research is needed in part because of a flourishing atmosphere outside of the NIMH. At least two dozen notable initiatives looking at social and environmental factors are underway that could contribute greatly to the understanding of factors outside of genetics that influence early brain development, Dr. Hoagwood said.

Those initiatives include about a dozen Medicaid accountable care organizations that are identifying social risks such as poverty, homelessness, food insecurity, and unemployment. Efforts aimed at addressing the effects of poverty through the adoption of strategies such as living wage laws also are underway, she said.

Dr. Hoagwood highlighted the importance of work on the exposome, which the NIMH has described as a new approach to understanding the mechanisms by which environmental factors alter brain and behavior – starting from prenatal development. Dr. Hoagwood said this approach would collect samples to systematically monitor a range of broad-spectrum environmental exposures. She described it as the “complement to the genomic sequencing.”

Exposures in children’s early years to factors such as concentrated poverty can set trajectories for life, Dr. Hoagwood said. She called for launching multisite studies to look at how such factors affect brain development, and where and how early interventions can improve children’s healthy development. Data from community efforts and some of those experiments might, at least initially, be “messy beyond belief,” she said.

“We have to not shy away from it. The genomic sequencing has not shied away from messy data,” Dr. Hoagwood said. “We don’t need to do that, either. We need new methods. We need small experiments of novel payment approaches. We need to use our data systems better.”

Dr. Hoagwood had no financial disclosures to report.

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