Suicide in the US: Finding Pathways to Prevention September 7, 2011

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As part of Suicide Prevention Awareness, NIMH is sponsoring a videocast panel of suicide prevention experts. This is a great opportunity to ask questions and hear directly from people working in the field.

When: September 7, 2011 from 2:00 to 3:30 PM EDT
Where: National Institute of Mental Health
6001 Executive Boulevard Rockville, Maryland 20852

This event will be videocast. Those who live in the area are welcome to join us as part of the live audience. Seating is limited.

Suicide Research Panel Invitation

Bending the Curve on Suicide

There has been so much concern in the mental health community about cutbacks in services and potential changes in funding, it’s easy to overlook an important, positive change in policy. Earlier this month, the White House announced that henceforth, soldiers who die by suicide while deployed in a war zone will be recognized just as others who die in service to this country. In an extraordinary statement, the President noted, “They didn’t die because they were weak.”

This statement was followed by a White House Blog post from the Army Vice Chief of Staff General Peter Chiarelli, who stated, “Many are struggling with the ‘invisible wounds’ of this war, including traumatic brain injury, post-traumatic stress, depression and anxiety. Any attempt to characterize these individuals as somehow weaker than others is simply misguided.”

Why this change in our approach to soldier suicides? Partly, this reflects recognition of the increasing rates of suicide in the military, rates that have doubled for the Army since 2004. While soldiers traditionally have lower rates of suicide relative to age and gender-matched civilians, the rates in the Army began exceeding civilian rates in 2008. Since 2010, more soldiers have died from suicide than in combat.

What is driving this increase in suicide? An NIMH-Army collaboration, the Army Study to Assess Risk and Resilience in Soldiers (Army STARRS), has been reviewing recent suicides, as well as mounting a prospective study of new and active duty soldiers, to answer this question. The results from reviewing 389 suicide deaths defy any simple or single explanation. There has been an understandable tendency to attribute the increasing rate to the rigors of a continuing war, with many soldiers experiencing multiple deployments and many affected by post traumatic stress disorder and traumatic brain injury. The risk for suicide has risen for all soldiers, regardless of whether they have been deployed, but the data show that a soldier’s risk for suicide is greatest while deployed. Army STARRS, modeled on the Framingham Heart Study, is still in its early phase, but over 17,000 soldiers have now enrolled. We expect that the prospective study can build on these retrospective results to define risk factors for suicide, just as the Framingham study identified risk factors for cardiovascular disease….

By Thomas Insel, M.D.
NIMH Director
http://www.nimh.nih.gov/about/director/2011/bending-the-curve-on-suicide.shtml

Mental Illness Defined as Disruption in Neural Circuits

It has become an NIMH mantra to describe mental disorders as brain disorders. What does this mean? Is it accurate to group schizophrenia, depression, and ADHD together with Alzheimer’s disease, Parkinson’s disease, and Huntington’s disease? Is a neurologic approach to mental disorders helpful or does this focus on the brain lead to less attention to the mind?

First, mental disorders appear to be disorders of brain circuits, in contrast to classical neurological disorders in which focal lesions are apparent. By analogy, heart disease can involve arrhythmias or infarction (death) of heart muscle. Both can be fatal, but the arrhythmia may not have a demonstrable lesion. In past decades, there was little hope of finding abnormal brain circuitry beyond the coarse approach of an EEG, which revealed little detail about regional cortical function. With the advent of imaging techniques like PET, fMRI, MEG, and high resolution EEG, we can map the broad range of cortical function with high spatial and temporal resolution. For the first time, we can study the mind via the brain. Mapping patterns of cortical activity reveals mechanisms of mental function that are just not apparent by observing behavior….

By Thomas Insel, M.D.
NIMH Director
http://www.nimh.nih.gov/about/director/2011/mental-illness-defined-as-disruption-in-neural-circuits.shtml

NIMH RAISE Project Makes Progress as Teams Refine Research Approaches

Researchers continue to make progress in the NIMH Recovery After an Initial Schizophrenia Episode (RAISE) Project, which seeks to intervene at the earliest stages of illness in order to prevent long term disability. Recent refinements to the two RAISE studies will ensure that RAISE continues efficiently, and generates results that will be relevant to consumers and health care policy makers.

The RAISE Early Treatment Program (ETP), led by John Kane, M.D., of the Feinstein Institute for Medical Research in Manhasset, NY, is now conducting a full-scale, randomized controlled trial comparing two different ways of providing treatment to people experiencing the early stages of schizophrenia and related disorders. Both types of treatment emphasize early intervention but feature different approaches for initiating and coordinating care. Treatment may include personalized medication treatment, individual resiliency training, and supportive services, such as family psychoeducation and education or employment assistance. A total of 34 study locations are scattered throughout the nation and are currently recruiting patients. ETP plans to recruit at least 400 patients for the study for up to two years of treatment and evaluation….

By Colleen Labbe
NIMH Press Office
http://www.nimh.nih.gov/science-news/2011/nimh-raise-project-makes-progress-as-teams-refine-research-approaches.shtml

New Neurons in Adult Brain Buffer Stress

New neurons growing in the adult brain help buffer the effects of stress, according to a new study in mice. Previous research has suggested that the growth of new neurons, or neurogenesis, in adults is involved in recovery from depression. This work provides evidence that loss of new neurons plays a role in the development of depression and suggests that the stress response is the link between adult neurogenesis and depressive illness….

By Charlotte Armstrong
NIMH Press Office
http://www.nimh.nih.gov/science-news/2011/new-neurons-in-adult-brain-buffer-stress.shtml

Psychiatry: Where are we going?

At the recent annual meeting of the American Psychiatric Association (APA), a talk by Dr. Laura Roberts caught my attention. In her presentation on “living up to our commitments,” Dr. Roberts, the new chair of Psychiatry at Stanford, described a dire situation for psychiatry in 2011. While some of the most disabling and deadly medical problems, neuropsychiatric illnesses, have become the leading source of medical disability in this country1, the discipline of psychiatry is often still struggling with issues of stigma, scandal, and self-doubt.

Consider these numbers. While 37.6% of practicing physicians are age 55 or older, in psychiatry nearly 55% are in this age range, ranking as the second oldest group of physicians, surpassed only by preventive medicine. Part of this aging cohort effect is the low rate of medical school graduates choosing psychiatry. Only 4% of US medical school seniors (n = 698) applied for one of the 1097 post-graduate year one training positions in psychiatry2. As Dr. Roberts noted, it is troubling that the area of medicine addressing the leading source of medical disability is also facing a shortage of new talent. Indeed, over the past decade the number of psychiatry training programs has fallen (from 186 to 181) and the number of graduates has dropped from 1,142 in 2000 to 985 in 2008. In spite of the national shortage of psychiatrists, especially child psychiatrists, 16 residency training programs did not fill with either U.S. or foreign medical graduates in 20113.

Beyond these numbers, the profession is struggling with its identity, a theme echoed in other plenary talks at the APA meeting. Traditionally, psychiatry has been the medical discipline that cultivates a rich relationship with patients, countering suffering with empathy and understanding. But a recent article in the New York Times reported that only 11% of psychiatrists perform psychotherapy and described a psychiatrist who ran his office “like a bus station,” seeing so many patients for 5 -10 minute medication checks that he had to train himself not to listen to his patient’s problems4….

Tom Insel, M.D.
NIMH Director
http://www.nimh.nih.gov/about/director/2011/psychiatry-where-are-we-going.shtml

Investing Wisely in Public Health

The biomedical philanthropist Mary Lasker once famously quipped, “If you think research is expensive, try disease.” This comment is even more relevant today, especially in thinking about the high costs of mental disorders.

Of course, this is a time of reduced funding across the federal government as Congress looks to rein in government spending. Members of both parties have stressed the need to reduce the deficit and cut spending. But this is why we must reframe the issue: is research an expense or an investment? The data argue for research as an investment — not a subsidy, entitlement, or conventional government cost.

Consider that NIH funding is an economic engine, creating $68 billion in new economic activity and nearly 500,000 jobs across 50 states in 2010. Recognizing the benefits of such an engine, other countries have begun making large new commitments to biomedical research. The Beijing Genome Institute has just purchased 128 of the new Illumina genomic sequencers, giving China a global edge for commercial sequencing. The Chinese government seems to have no doubt that the economic benefits of research accrue to those making the largest and smartest investments.

One such investment closer to home, The American Recovery and Reinvestment Act (ARRA), can now be viewed as an experiment in investing new research dollars. As part of ARRA, NIMH received $374 million for a two-year investment in 2009. Some of those funds supplemented grants that had been cut back in the preceding years. Some expanded the pool of grants with short-term awards. Some was used to boost the Institute’s autism portfolio.

But the biggest portion went into four signature projects aimed at changing our science. Two years later we can see the return on this investment in a series of new, transformative resources. The Recovery After an Initial Schizophrenia Episode (RAISE) Project, now in 35 sites, is optimizing the various approaches to early intervention following a first episode of psychosis. RAISE has the twin goals of improving clinical outcomes for patients and informing payors of what they could and should cover to avoid long-term disability….

Tom Insel, M.D.
NIMH Director
http://www.nimh.nih.gov/about/director/2011/investing-wisely-in-public-health.shtml

Mental Health: Think Globally, Act Locally

Accessing mental health care can be a struggle for many people around the world, in high- as well as middle- and low- income countries, and may be intertwined with a host of other, seemingly unrelated difficulties. For example, a recent story on Public Radio International reported that, for men and women with mental illness in Uganda, access to care is one part of the treatment, but securing a livelihood is an equally important next step; yet, few organizations offer assistance, and discrimination against people with mental disorders can reduce opportunities. As the ranks of unemployed and underemployed Americans continue to grow, this story is becoming more common in the U.S. as well.

These global commonalities represent an opportunity for us to learn from the experiences in other countries or among other cultures to help improve mental health care in the U.S. Using the wisdom of global shared experience, along with varied perspectives, might help psychiatry as a field to find reasonable and rational solutions to reduce the burden of mental illness. At the same time, a coordinated, global response to the major problems facing people with mental illness could speed progress toward solutions.

Today, Nature published the Grand Challenges in Global Mental Health, a synthesis of the views of more than 400 researchers, advocates, and clinicians working in more than 60 countries on mental health issues. Research specifically focused on solving these challenges could significantly transform the field and the lives of people with mental disorders. This initiative provides many reasons for excitement, but three in particular are foremost in my mind….

Tom Insel, M.D.
NIMH Director
http://www.nimh.nih.gov/about/director/index.shtml

Suicide Prevention Research Panel Symposium September 7, 2011

Ask the Experts!

As part of Suicide Prevention Awareness, NIMH is sponsoring a videocast panel of suicide prevention experts. This is a great opportunity to ask questions and hear directly from people working in the field.

When: September 7, 2011 from 2:00 to 3:30 PM EDT
Where: National Institute of Mental Health
6001 Executive Boulevard
Rockville, Maryland 20852

Those who live in the area are welcome to join us as part of the live audience. Seating is limited.

Details on the videocast and registration information will be available soon.

Don’t miss this chance to speak with the experts on suicide prevention

NIMH Outreach Partnership Program Update for July 1, 2011

The Outreach Partnership Program is a nationwide outreach initiative of the National Institute of Mental Health (NIMH) that enlists state and national organizations in a partnership to help close the gap between mental health research and clinical practice, inform the public about mental illnesses, and reduce the stigma and discrimination associated with mental illness. For more information about the program please visit: http://www.nimh.nih.gov/outreach/partners. To subscribe to receive the Update every two weeks, go to: http://www.nimh.nih.gov/outreach/partnership-program/subscribe-to-the-update.shtml

NIMH_Update_7-1-11