Congress Told Why MH Funding Will Determine Field's Future

Exciting advances in brain research are on the verge of transforming the care for millions of mentally ill patients, but researchers need more funding from the federal government to support the efforts to bring new discoveries to the bedside, said psychiatric experts at a congressional briefing organized by APA.

The briefing, “The Science Behind Mental Health,” was held May 13 at the Cannon House Office Building in Washington, D.C. Lead congressional sponsors were Reps. Grace Napolitano (D-Calif.) and Timothy Murphy (R-Pa.), co-chairs of the House Mental Health Caucus. The presentations gave congressional staffers a glimpse of how scientific advances are revealing important facts about schizophrenia.

Jeffrey Lieberman, M.D., chair of APA's Council on Research and the Department of Psychiatry at Columbia University, explained how critical it is for the National Institute of Mental Health (NIMH) to support the training and work of brilliant psychiatric researchers in various stages of their careers. Their scientific endeavors have uncovered many biological mysteries of how severe mental illnesses originate and develop and how new treatments are being designed thanks to these understandings. “The best, I'm happy to tell you, is yet to come,” said Lieberman.

David Lewis, M.D., director of the translational neuroscience program and a professor of psychiatry and neuroscience at the University of Pittsburgh Medical Center, described his team's research on the brains of patients with schizophrenia. Showing imaging photos of brain activities, he pointed to the areas that light up in schizophrenia patients and healthy volunteers when they perform cognitive tests and described what goes wrong in the dorsolateral prefrontal cortex that impairs patients' working memory.

Based on the role of GABA neurons in coordinating neuronal activities in this brain region and their defects in schizophrenia, Lewis and colleagues are testing a molecule known as MK-0777 that specifically acts on GABA receptors to perform the function of the diseased, defective GABA neurons. As an example of rational drug discovery, they conducted a double-blind, placebo-controlled study in which schizophrenia patients performed better on cognitive tests when they were given the active drug than when they took placebo.

“Neuroimaging is still a fairly young field,” Laura Rowland, Ph.D., an assistant professor of psychiatry at the University of Maryland School of Medicine, explained at the briefing. “Ultimately what we want to do with this tool is be able to predict who will develop a mental illness, who will respond to a specific treatment, and the disease's onset and exacerbation.”

This prospect was echoed by Lewis, who noted that the field of psychiatry is devoting a lot of talent and resources to finding novel approaches to detect mental illness risks early in life and prevent or limit the development of psychiatric disorders.

One of the key lessons, these experts noted, is that behavioral symptoms of mental illness can now be quantified and visualized with brain imaging and other technologies. “Neuroimaging ... provides a bridge between what we observe in behavior ... and what's going on in the brain,” said Rowland. These new tools will help physicians better diagnose and treat patients, just like the tests and tools, such as X-ray imaging and blood tests, used in other types of diseases do.

Educating lawmakers and the public about the science of mental health can also help decrease mental illness stigma and misunderstanding. However, the researchers pointed out that the advances and educational efforts needed to accomplish this require government support through funding and policies.

Unlike other medical specialties, “there is a lot of opposition to psychiatry, mental illness, and brain research that has to be overcome,” said Lieberman. He pointed out that the federal government's funding for NIMH and psychiatric research and services is proportionally lower than that for many other types of medical disorders, despite the large public-health burden of mental illness.

The bipartisan Mental Health Caucus was established in 2003 and has more than 90 members from the House of Representatives. Attending the briefing were congressional staff from offices of lawmakers including Rep. Pete Stark (D-Calif.), chair of the Ways and Means Health Subcommittee; Rep. Edolphus Towns (D-N.Y.), chair of the Oversight and Government Reform Committee; and Rep. Nita Lowey (D-N.Y.), a member of the Appropriations Committee. ▪