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Meeting Summary

Innovation in Mental Health Research: What? How? How Much?

October 17, 2005
Potomac, Maryland

Sponsored by the:
Division of Services and Intervention Research and
Division of Extramural Activities of the National Institute of Mental Health

Introduction

On October 17, 2005 the Division of Services and Intervention Research (DSIR) and the Division of Extramural Activities (DEA) of the National Institute of Mental Health (NIMH), brought together more than 100 NIMH staff, current NIMH reviewers and current and future grant applicants to discuss innovation as it applies to mental health research; more specifically mental health research in the areas of interventions and services.

The goals of this workshop were to:

Additionally, workshop participants were asked to discuss how they, as individuals, value and weigh innovation (including identifying their own level of risk tolerance) when reviewing grant applications.

Main Activities and Themes

The day was structured around a video presentation, guest speakers, panel discussions, and breakout groups. The presentations were designed to present different viewpoints regarding what might constitute innovation and to stimulate discussion. Presentations focused on innovation from multiple disciplines, including industry and biotechnology, and served to illustrate for participants that innovation can be defined multiple ways and is often seen as closely related to invention and discovery. Within intervention and services related mental health research, the innovation is often likely to be related to the methodology used to develop a new intervention or new techniques to bring that intervention into widespread use (i.e. dissemination). Panel discussions following the talks further highlighted how the more common view of innovation as invention and discovery-based does not easily translate for mental health intervention and services research. A single definition of innovation for mental health research was not easily identified, but examples presented included research that was paradigm-shifting in its methodology, target population, and analytic approach.

The new NIH review criterion regarding innovation was discussed. Themes in the newly stated criterion include:

  1. Is the research original and innovative?
  2. Does the research challenge existing paradigms?
  3. Does the research challenge existing clinical practice?
  4. Does the research address an innovative hypothesis?
  5. Does the research address a critical barrier to progress in the field?
  6. Does the research develop or employ novel concepts, approaches, methodologies, tools, or technologies?

Some themes that emerged during the day were:

Breakout Groups

Breakout groups developed and deepened the discussion on innovation. Each group was instructed to brainstorm about the definition of innovation and about ways to improve consideration of innovation in the review process. The groups provided their thoughts and suggestions, and several themes emerged from these sessions. First, innovation was defined in a number of ways, including transfer of knowledge, meeting an unmet need, opening a new area, and improving the utility of existing research or treatment designs. Groups also noted that innovation could be evidenced in many different aspects of the grant application, including theory, intervention, methods, setting, outcomes, impact, and target populations.

Through the breakout groups, it became evident that while reviewers are eager to be supportive of innovation in grant applications, there is a contradictory expectation that scientifically strong research be clearly based on existing theory and practice. Participants expressed concerns that the more innovative the project, the less feasible the design, and that greater background information or the inclusion of accomplished researchers would therefore be necessary to allow reviewers to take the leap the application requested.

The breakout groups also made suggestions for improving attention to innovation in grant reviews. Several suggestions were made that focused on reviewer training, particularly to inform reviewers about current priorities and gaps in the field, and to help reviewers know how much weight to put on individual review criteria. Related to these training suggestions were ideas for developing a weighting scheme for the different evaluation criteria; significance, approach, and innovation were particularly singled out as possibly receiving separate scores that would be aggregated to provide the overall score for each application. This process would allow reviewers to systematically evaluate innovation as a priority area. Different weights for each of the evaluation criteria could be provided for the different grant mechanisms since some of the grant mechanisms are more focused on innovation. There was a sense that greater communication between review and applicants during the review process, such as through live question and answer sessions, would help reviewers be less risk-averse.

Suggestions from the breakout groups also focused on the development of grant mechanisms more specifically tailored to encourage innovation. Some participants suggested providing more opportunities for training and adjunct studies which could lead to innovative ideas being piloted. Increasing institutional support for innovation could be achieved through matching funds to universities and other institutions. It was also reported that encouragement of greater dialogue and collaboration between new and seasoned investigators could lead to innovative research that was also feasible.

Closing Remarks from Dr. Tom Insel and Summary

In his closing remarks, Dr. Insel noted that the NIMH mission is to “reduce the burden of mental illness and behavioral disorders through research on mind, brain and behavior.” He cited NIH’s definition of innovation as gauging whether a project challenges existing paradigms or clinical practice, addresses an innovative hypothesis or critical barrier in the field, develops or employs novel concepts, approaches, methodologies, tools, or technologies for this area. NIH’s support for innovation includes the NIH Roadmap, the Pioneer Awards, supporting inter-disciplinary research, reaching out to new principal investigators, and the Neuroscience Blueprint’s search for new ideas. Within NIMH, the Innovation Committee has $1.5 million to identify grants (via the R56 mechanism) that have potential to shift paradigms or involve high risk-high payoff research. Dr. Insel said innovation is a process, a means to an end — “not the endgame.”

Although mental health professionals attribute some of the field’s challenges to the stigma surrounding mental illness, Dr. Insel pointed out that researchers need to set the standard for mental health research as high as in research on heart disease and other areas. The kinds of revolutionary technologies used in other fields — such as molecular diagnostics, proteomics, neuroimaging and clinical genomics — are needed to evolve the mental health field from its current state of diagnosis by symptom, to treatment of the core pathology and, finally, strategic prevention. This ultimate innovation will move the mental health field from merely understanding the pathophysiology of mental illness to offering a personalized care strategy that features prevention, treatment and cures.

In sum, the day helped participants understand that the challenge of reducing the burden of mental illness demands innovation. While we have more treatments that help more people than ever, much remains to be done. This workshop helped to alert the investigator and reviewer communities that indeed, NIMH is not only looking for innovative research but is in fact encouraging it.

Next Steps

Workshop organizers, Drs. Samia Noursi, David Sommers, and Marina Broitman, are planning to continue the discussion initiated on October 17, 2005, and to work towards increasing the focus on innovation in grant applications and their review. To facilitate this, the following activities are planned:

For further information about this workshop and planned activities, you may contact Dr. Samia Noursi, snoursi@mail.nih.gov, (301) 443-2638; Dr. David Sommers, dsommers@mail.nih.gov, (301) 443-7861; or Dr. Marina Broitman, mbroitma@mail.nih.gov, (301) 402-8152.