How to help the mentally ill in a time of shrinking budgets

Barely a day goes by without news of some deeply disturbed individual killing innocent people during a violent rampage. But these are just the most dramatic and public examples of our escalating mental health crisis. Today, there are more than 60 million American adults—one in four—living with mental illness. Our prisons are filled with people suffering from serious mental illness, particularly psychosis, and some reports estimate the rate of suicides by veterans suffering from PTSD and depression at 22 per day. In fact, the World Health Organization predicts that by 2030, depression will be the leading cause of disease burden globally. 

You don’t have to be a psychiatrist to know our society has a serious mental health problem.

{mosads}To address this issue, we need facilities and practitioners who can help people with mental illness and support research that will lead to faster diagnosis and more effective treatments. But even as this crisis escalates, funding for scientific research is on the decline. For example, the National Institute of Mental Health (NIMH) now has an annual budget of $1.4 billion, a figure that has declined over 10 percent in real terms in the last five years when adjusted for inflation, meaning less funding for both basic and clinical research.

Scarce resources have led to increased competition for federal grants, lab closures and, distressingly, a lack of incentives for young people who wish to pursue careers in research. This is true even in neuroscience, a scientific field that has generated great excitement in recent years.

Increasingly, it is private funding that is driving the kind of high-risk, high-reward research that may change lives and end the suffering that psychiatric illness brings to so many.

Some in the scientific community are worried by this trend; they suspect that wealth will trump peer reviews and the impartial determination of scientific merit. I have a different view: many philanthropists are serious, knowledgeable, deeply committed and determined to find cures for the most intractable illnesses. For those of us who have devoted our lives to scientific research, there is a lot to appreciate about this new world order. 

In today’s funding environment, the most significant paths to scientific discovery will be underwritten by a combination of public and private funding from people with a vested stake in finding cures. Just look at the progress made by public-private partnerships such as the American Cancer Society, the Cystic Fibrosis Foundation, and the Bill and Melinda Gates Foundation.

Over many years, I have been privileged to work in both the public and private sectors. In 1984, I left my post as NIMH Director for Columbia University because I felt I could accomplish more on the outside. In those early days in New York, I set up an annual information symposium about mental health for the public, featuring scientists talking about psychiatric research in plain English. This event attracted hundreds of people starved for information, and enhanced  the work of  the Brain & Behavior Research Foundation (BBRF), which has awarded more than 5,000 grants worth some $340 million. More important, it has seeded the research of an entire generation of brilliant young neuroscientists and clinicians, who have gone on to obtain $3 billion in additional funding for their work. This is a philanthropic model worthy of emulation.

Today, people living with mental illness certainly have access to more help than they did when I trained to become a psychiatrist in the early 1960s. Most people know a friend or family member grappling with mental illness and, as a result, people are often more sympathetic and aware of the impact of psychiatric disorders. Sadly, though, well publicized violent incidents involving people with mental illness continue to reinforce lingering stigmas. Decades after the deinstitutionalization of mentally ill patients, we still lack adequate community support, psychiatrists, psychologists, social workers, psychiatric nurses, and hospital beds.

That is why it is so important that scientists continue conducting basic research to understand how the healthy human brain gives rise to the miracle of thought and consciousness, and how genetic, cellular and circuit anomalies lead to the full panoply of brain disorders.

But those grand insights are still some years in the future.

Until then, much needs to be done. How does mental health become a top priority so that help is available to all who need it? This problem has deep roots, and solutions are elusive and complex. 

It is time to stop talking about helping people with psychiatric illness and actually do something to help them lead productive lives. Partly because of the logjam in Washington, enlightened philanthropists have never had a more important role to play in leading brain research forward.   

This does not, however, absolve our elected representatives, whose leadership has never been more needed on this issue. Though it is difficult to imagine what our ultra-partisan political system can accomplish in the face of this problem, Congress must find ways to fund mental health research. 

Pardes is the former president & CEO of New York-Presbyterian Hospital; chair of Psychiatry at Columbia University School of Physicians & Surgeons; and director of the National Institute of Mental Health.


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