National Institute of Mental Health

Organizational history

NIMH had passed through a series of name changes and organizational arrangements with in the United States Public Health Service (PHS) throughout its history:^[8]

• PHS Narcotics Division (1929–30) (Not to be confused with the Bureau of Prohibition Narcotics Division)
• PHS Division of Mental Hygiene (1930–43)
• Mental Hygiene Division, within the PHS Bureau of Medical Services (1943–49)
• National Institute of Mental Health (NIMH), one of the National Institutes of Health (NIH, 1949–67)
• NIMH as an independent division of the PHS (1967–68)
• NIMH, within the Health Services and Mental Health Administration (1968–73)
• NIMH, within NIH (1973)
• NIMH, within the Alcohol, Drug Abuse, and Mental Health Administration (1973–1992)
• NIMH, within NIH (1992–present)

In 1992, when the Alcohol, Drug Abuse, and Mental Health Administration was abolished, NIMH was transferred to NIH, retaining its research functions while its treatment services were transferred to the new Substance Abuse and Mental Health Services Administration.^[8]

Prohibition era

During the Prohibition era, the Narcotics Division of the Bureau of Public Health was responsible for the patients confined to the "narcotic farms" that had been a result of the Narcotic Farms Act of 1929.^[9] Confusingly, the Bureau of Prohibition which was also in the Treasury had in its organizational structure a Narcotics Division whose Deputy Commissioner was Levi G. Nutt, an advocate of forced confinement of addicts to the narcotic farms.

Functions

Mental health has traditionally been a state responsibility, but after World War II there was increased lobbying for a federal (national) initiative. Attempts to create a National Neuropsychiatric Institute failed. Robert H. Felix, then head of the Division of Mental Hygiene, orchestrated a movement to include mental health policy as an integral part of federal biomedical policy. Congressional subcommittees hearings were held and the National Mental Health Act was signed into law in 1946. This aimed to support the research, prevention and treatment of psychiatric illness, and called for the establishment of a National Advisory Mental Health Council (NAMHC) and a National Institute of Mental Health. On April 15, 1949, the NIMH was formally established, with Felix as director. Funding for the NIMH grew slowly and then, from the mid-1950s, dramatically. The institute took on a highly influential role in shaping policy, research and communicating with the public, legitimizing the importance of new advances in biomedical science, psychiatric and psychological services, and community-based mental health policies.^[10]

In 1955, the Mental Health Study Act called for "an objective, thorough, nationwide analysis and reevaluation of the human and economic problems of mental health."^[4] The resulting Joint Commission on Mental Illness and Health prepared a report, "Action for Mental Health", resulting in the establishment of a cabinet-level interagency committee to examine the recommendations and determine an appropriate federal response.

In 1963, Congress passed the Mental Retardation Facilities and Community Mental Health Centers Construction Act, beginning a new era in Federal support for mental health services. NIMH assumed responsibility for monitoring the Nation's community mental health centers (CMHC) programs.

During the mid-1960s, NIMH launched a campaign on special mental health problems. Part of this was a response to President Lyndon Johnson's pledge to apply scientific research to social problems. The institute established centers for research on schizophrenia, child and family mental health, suicide, as well as crime and delinquency, minority group mental health problems, urban problems, and later, rape, aging, and technical assistance to victims of natural disasters.

Alcohol abuse and alcoholism did not receive full recognition as a major public health problem until the mid-1960s, when the National Center for Prevention and Control of Alcoholism was established as part of NIMH; a research program on drug abuse was inaugurated within NIMH with the establishment of the Center for Studies of Narcotic and Drug Abuse.

In 1967, NIMH separated from NIH and was given bureau status within PHS. However, NIMH's intramural research program, which conducted studies in the NIH Clinical Center and other NIH facilities, remained at NIH under an agreement for joint administration between NIH and NIMH. Secretary of Health, Education, and Welfare John W. Gardner transferred St. Elizabeths Hospital, the Federal Government's only civilian psychiatric hospital, to NIMH.

In 1968, NIMH became a component of PHS's Health Services and Mental Health Administration (HSMHA).

In 1970, the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act (P.L. 91-616) established the National Institute of Alcohol Abuse and Alcoholism within NIMH.

In 1972, the Drug Abuse Office and Treatment Act established a National Institute on Drug Abuse within NIMH.

In 1973, NIMH went through a series of organizational moves. The institute temporarily rejoined NIH on July 1 with the abolishment of HSMHA. Then, the DHEW secretary administratively established the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) – composed of the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, and NIMH – as the successor organization to HSMHA. ADAMHA was officially established in 1974.

The President's Commission on Mental Health in 1977 reviewed the mental health needs of the nation and to make recommendations to the president as to how best meet these needs in 1978. In August 1977, The Washington Post reported that senior directors at the NIMH were likely aware of the institute's covert participation in the Central Intelligence Agency's MKUltra experiments, administering LSD to federal prisoners in Lexington, Kentucky.^[11]

In 1980, The Epidemiologic Catchment Area (ECA) study, an unprecedented research effort that entailed interviews with a nationally representative sample of 20,000 Americans was launched. The field interviews and first wave analyses were completed in 1985. Data from the ECA provided a picture of rates of mental and addictive disorders and services usage.

The Mental Health Systems Act of 1980 – based on recommendations of the President's Commission on Mental Health and designed to provide improved services for persons with mental disorders – was passed. NIMH participated in development of the National Plan for the Chronically Mentally Ill, a sweeping effort to improve services and fine-tune various Federal entitlement programs for those with severe, persistent mental disorders.

In 1987, administrative control of St. Elizabeth's Hospital was transferred from the NIMH to the District of Columbia. NIMH retained research facilities on the grounds of the hospital. The NIMH Neuroscience Center and the NIMH Neuropsychiatric Research Hospital, located on the grounds of St. Elizabeth's Hospital, were dedicated in 1989.

In 1992, Congress passed the ADAMHA Reorganization Act, abolishing ADAMHA. The research components of NIAAA, NIDA and NIMH rejoined NIH, while the services components of each institute became part of a new PHS agency, the Substance Abuse and Mental Health Services Administration (SAMHSA). The return to NIH and the loss of services functions to SAMHSA necessitated a realignment of the NIMH extramural program administrative organization. New offices were created for research on Prevention, Special Populations, Rural Mental Health and AIDS.

In 1994, The House Appropriations Committee mandated that the director of NIH conduct a review of the role, size, and cost of all NIH intramural research programs (IRP). NIMH and the National Advisory Mental Health Council (NAMHC) initiated a major study of the NIMH Intramural Research Program. The planning committee recommended continued investment in the IRP and recommended specific administrative changes; many of these were implemented upon release of the committee's final report; other changes — for example, the establishment of a major new program on Mood and Anxiety Disorders — have been introduced in the years since.

In 1996, NIMH, with the NAMHC, initiated systematic reviews of a number of areas of its research portfolio, including the genetics of mental disorders; epidemiology and services for child and adolescent populations; prevention research; clinical treatment and services research. At the request of the National Institute for Mental Health director, the NAMH Council established programmatic groups in each of these areas. NIMH (National Institute of Mental Health) continued to implement recommendations issued by these Workgroups.

In 1997, NIMH realigned its extramural organizational structure to capitalize on new technologies and approaches to both basic and clinical science, as well as changes that had occurred in health care delivery systems, while retaining the institute's focus on mental illness. The new extramural organization resulted in three research divisions: Basic and Clinical Neuroscience Research; Services and Intervention Research; and Mental Disorders, Behavioral Research and AIDS.

Between 1997 and 1999, NIMH refocused career development resources on early careers and added new mechanisms for clinical research. It also launched mentorship initiatives and expanded funding for early-career researchers, fostering a diverse pipeline of mental health professionals.

In 1999, The NIMH Neuroscience Center/Neuropsychiatric Research Hospital was relocated from St. Elizabeth's Hospital in Washington, D.C., to the NIH Campus in Bethesda, Maryland, in response to the recommendations of the 1996 review of the NIMH (National Institute of Mental Health) Intramural Research Program by the IRP Planning Committee.

The first White House Conference on Mental Health, held June 7, in Washington, D.C., brought together national leaders, mental health scientific and clinical personnel, patients, and consumers to discuss needs and opportunities. The National Institute on Mental Health developed materials and helped organize the conference.

U.S. Surgeon General David Satcher released The Surgeon General's Call To Action To Prevent Suicide, in July, and the first Surgeon General's Report on Mental Health, in December. NIMH, along with other federal agencies, collaborated in the preparation of both of these landmark reports.

Since the appointment of Thomas R. Insel as Director of NIMH in 2002, the institute has undergone organizational changes to better target mental health research needs (the expansion from three extramural divisions to five divisions, with the two new divisions focusing on adult and child translational research). NIMH also weathered several years of controversy due to conflict of interest and ethics violations by some of its intramural investigators. This situation cast light on an area that affected all of NIH and resulted in more stringent rules about conflict of interest for all of NIH. Recently, Congressional interest turned to ethics and conflict of interest concerns with external investigators who receive NIMH or other NIH support. Current federal law has responsibility for managing and monitoring conflict of interests for external investigators with their home institutions/organizations. NIH responded to these new concerns by initiating a formal process for seeking public input and advice that will likely result in a change to the rules for monitoring and managing conflict of interest concerns for externally supported investigators. Finally, the past decade has also been marked by exciting scientific breakthroughs and efforts in mental illness research, as new genetic advances and bioimaging methodologies have increased understanding of mental illnesses. Two notable consequences of these advances are the institute's collaboration with the Department of Army to launch the Study To Assess Risk and Resilience in Service Members (STARRS), a Framingham-like effort scheduled to last until 2014 and the Research Domain Criteria (RDoC) effort, which seeks to define basic dimensions of functioning (such as fear circuitry or working memory) to be studied across multiple levels of analysis, from genes to neural circuits to behaviors, cutting across disorders as traditionally defined.^[12][13]

A collection of interviews with directors and individuals significant in the foundation and early history of the institute conducted by Dr. Eli A. Rubenstein between 1975 and 1978 is held at the National Library of Medicine in Bethesda, Maryland.^[14]