Schizophrenia, clinical and basic research at NIMH: A 75 Year retrospective

Abstract

Objective: In 2024, NIMH is celebrating its 75th anniversary. At the Congressional hearings preceding its initial funding in 1949, witnesses stressed the need for NIMH to carry out clinical and basic research to find the causes and better treatments for severe mental illnesses. Patients with schizophrenia alone were said to occupy one quarter of all hospital beds in the U.S. We therefore sought to ascertain the relative importance of clinical and basic research funded by NIMH over the life of the institute, using schizophrenia as our primary example.

Methods: We used information of published studies, from the NIMH website, and from NIMH employees both past and present.

Results: During its first 40 years, NIMH funded clinical and basic research approximately equally. That changed in the 1990s when the funding of the Human Genome Project started a shift in research resources from clinical to basic. By 2015, clinical research at NIMH had been reduced to 10 % of the research portfolio. This decline has continued and been well documented. For example, between 2006 and 2023, NIMH-funded extramural drug trials for schizophrenia and bipolar disorder decreased by 95 %. To clearly illustrate the decline of schizophrenia research at NIMH, research for the 5-year period from 1984 to 1988 was compared with research from 2018 to 2022.

Conclusions: In summary, data suggests that over the past 3 decades NIMH has reduced clinical research on severe mental illnesses by at least 90 %. We therefore recommend that NIMH re-establish clinical research on severe mental illnesses as a priority, as originally intended by Congress; that NIMH spend at least 50 % of all disease-related research dollars on clinical research; and that this distribution be documented in an existing and publicly available database.

Keywords: Clinical research; National Institutes of Mental Health; Research priorities; Schizophrenia.