Environmental Factor

April 2011

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NIMH director reaches out to NIEHS

By Ernie Hood
April 2011

Thomas Insel, M.D.

Insel expressed some concern about current public health outcomes in mental health, but told the NIEHS audience that new thinking about mental disorders offers hope for significant improvements. (Photo courtesy of Steve McCaw)

Paul Wade, Ph.D. and Robert Sills, D.V.M., Ph.D.

Insel's talk attracted scientists from the Division of Intramural Research, such as Principal Investigator Paul Wade, Ph.D., center left, as well as the National Toxicology Program, such as Chief of the Cellular and Molecular Pathology Branch Robert Sills, D.V.M., Ph.D., right. (Photo courtesy of Steve McCaw)

Richard Woychik, Ph.D.

NIEHS Deputy Director Richard Woychik, Ph.D., appeared contemplative as Insel describedthe common ground between the research agendas of the two institutes. (Photo courtesy of Steve McCaw)

Kim McAllister, Ph.D.

Division of Extramural Research and Training program administrators, such as Kim McAllister, Ph.D., center, were interested in ways NIEHS and NIMH could collaborate in future grant programs. (Photo courtesy of Steve McCaw)

Director of the National Institute of Mental Health (NIMH) Thomas Insel, M.D., explored the topic of "Why NIMH Cares About NIEHS" during a presentation March 1 hosted by NIEHS/NTP Director Linda Birnbaum, Ph.D.

Insel told his audience that the two sister institutes have more in common than most would think, due to the growing evidence of links between environmental exposures and mental health. He also reached out for help from the environmental health sciences community in addressing an important public health issue by searching for answers to some of the most urgent questions in mental health research.

A revolution in neuroscience

Insel began his remarks by describing the current profound shift in thinking about mental disorders. "We are in the middle of a revolution in neuroscience, particularly in our understanding of mental illness," he said. "It requires a fundamental change in the way we think about the illnesses, even in the basic science that is the foundation for what we do."

He noted that even with the extraordinary successes in biomedical research over the past half-century, none have involved the diseases of main concern to NIMH-schizophrenia, bipolar disorder, major depression, eating disorders, ADHD in children, and several other mental disorders. "I think by almost any measure of public health outcomes in terms of morbidity and mortality, we have failed on almost every one of the disorders for which we are responsible," Insel added.

According to the sobering statistics Insel cited, mental disorders are the largest source of disability from all medical causes, a major cause of death, and one of the major drivers of health care costs, both inside and outside the system. The most recent estimate from 2008 is that direct and indirect costs of mental disorders total more than $317 billion annually.

An evolving paradigm in mental health

Although the track record is bleak, he explained, there are still reasons to be optimistic. "Part of the reason that we have failed in so many ways is because we haven't thought about these disorders in the right way," said Insel. "Much of the focus for the last century in thinking about serious mental illness has come from the standpoint of these being mental or behavioral problems which require mental or behavioral interventions...In the last decade or so, we've seen a completely different way of approaching these illnesses, and we think that offers real hope for transforming those kinds of statistics and moving the dial."

Potential areas for collaboration

Insel described the disruptive innovations taking place in mental health that profoundly influence the scientific approach being pursued at NIMH. He said that mental disorders are brain and developmental disorders that result from complex genetic risk plus experiential factors. Those disruptive innovations create a nexus with the types of research conducted by NIEHS, and Insel pointed to three areas where collaboration with NIEHS scientists could be productive:

  • Autism - "This is not a rare disease anymore," Insel claimed, and the considerable increase in prevalence in recent years cannot be explained simply by increased diagnosis. "What I would love your help with is figuring out what are the drivers here," he said, noting that changes in epigenetics due to environmental exposures may be a major factor.
  • Military suicides - Insel noted that military suicides have more than doubled over the past five years and now exceed combat deaths. Emerging research suggests that early trauma may be involved in later susceptibility, as developmental programming goes off-course.
  • The microbiome - According to Insel, recent research in mice has shown that normal gut microflora modulate brain development and behavior, leading to intriguing hypothetical interfaces between the biology of the microbiome, neurophysiology, and human psychology. "It's a place where NIMH would love to work with NIEHS," said Insel, "as we think about how this whole area of biology affects the development of brain and behavior."

(Ernie Hood is a contract writer for the NIEHS Office of Communications and Public Liaison.)

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