Goal 3: Strive for Prevention and Cures

Strive for Prevention and Cures

We need to develop better ways to prevent and treat mental illnesses. To achieve that goal, we need validated targets for interventions; new methods of intervention; improved methods to match interventions to individuals and populations; and, strategies for scaling interventions for the greatest public health impact. 

A target may be a disease mechanism, a factor related to a disease mechanism, or a factor that confers significant risk. Appropriate targets will depend on the intervention modality and the conceptual framework underlying hypotheses about its mechanism of action. Interventions may encompass prevention and treatment, consider all therapeutic modalities (e.g., pharmacologic, psychosocial, behavioral, device-based, biologics), and include structural changes (e.g., policies). Many protective/promotive factors are at intrapersonal and interpersonal levels, such as presence of a trusted adult or cultural connectedness. The socio-ecological levels beyond the individual level are also potent risk factors that underlie mental health disparities. Research should strive to identify strategies for influencing modifiable factors for the development, testing, and implementation of prevention and treatment interventions, including approaches that are relevant and acceptable to communities impacted by health disparities.

Robust clinical studies require testable hypotheses on how an intervention will engage a relevant target. Interventions should aim to modify targets, based on a hypothesis that such modification will result in improved symptoms, behavior, or functional outcomes. Evaluating the relationship between modification of targets and clinical outcomes allows us to fine-tune our understanding of risk for mental illnesses and helps us to prioritize the most promising interventions. This idea underlies NIMH’s experimental therapeutics approach by which interventions serve not only as potential therapies or preventive strategies, but also as probes to generate objective information about mechanisms of illness and/or resilience. Through the experimental therapeutics approach, information from a research study has scientific value relevant to the condition in question, irrespective of the intervention’s success.

Precision in mental health care means that individuals and populations will receive preventive and treatment interventions that are optimally matched to their characteristics and needs, across disease stages, diagnostic categories, cultures, environments, and the lifespan. Optimizing interventions will not only require consideration of symptoms and functioning, but also a broader consideration of etiologies, intervention, preferences of patients and families, and the contexts of intervention delivery.

NIMH supports the development and testing of preventive as well as treatment interventions, recognizing that many mental illnesses begin well before adulthood and often before symptoms appear or daily functioning is impaired. We need preventive interventions for delivery early in the course of illness and early in life for at-risk individuals, plus treatment interventions to mitigate mental illnesses and associated dysfunction at the earliest possible opportunity. NIMH encourages the development and testing of preventive and early interventions that can be delivered in a developmentally appropriate manner (e.g., at known sensitive periods and at key transitions) as early in life as possible and early in the illness course, to prevent or forestall mental illnesses and associated functional impairment.

The following Objectives further define this Goal:

The experimental therapeutics approach focuses not only on testing whether new interventions show clinical benefit, but, more importantly, on a staged approach where researchers initially establish confidence that the intervention is acting on the presumed target in humans, through a dose-dependent relationship, when appropriate. If successful, larger clinical trials would serve to reconfirm target engagement and further assess clinical impact of the potential intervention. If the interventions do not work in the expected manner, negative results are likewise scientifically informative and fundamental. In the case of an intervention engaging the target but failing to demonstrate a clinical effect, the target would be disqualified. If the intervention fails to adequately engage the target, the intervention would be disqualified from further consideration.

The experimental therapeutics framework also recognizes that clinical targets may differ qualitatively and quantitatively throughout the life course. Therefore, there needs to be a strong scientific premise for selecting clinical targets within a particular age range. Additionally, the dose of an intervention that is safe and effective for target engagement may be age- or developmental stage-dependent and should be systematically established in advance of efficacy testing. It is also recognized that multiple targets often need to be engaged to exert beneficial outcomes.

To more effectively develop new preventive and treatment interventions based on novel genomic, engineering, neurobiological, and behavioral advancements, NIMH will support research that employs the following Strategies:

Strategy 3.1.: A Developing novel interventions using a mechanism-informed, experimental therapeutics approach

Interest areas include:

  1. Enhancing the predictive value of preclinical assays used to select targets, drug candidates, circuit-based or cognitive/behavioral interventions, devices, and biologics for clinical development.
  2. Developing strategies to identify any missing elements in preclinical data to better inform future clinical trial designs.
  3. Identifying preventive and treatment intervention targets appropriate to age and stage of illness, and testing interventions to modify those targets to prevent or improve symptoms. Putative targets should be based on scientific discoveries that advance our understanding of the mechanisms and trajectories of mental resilience and illnesses.
  4. Developing promising preventive and therapeutic intervention strategies that target specific molecular, cellular, neural circuit, psychological, intrapersonal, interpersonal, social, and other upstream mechanisms driving core domains of cognitive, behavioral, and affective function that are disrupted in mental illnesses, including those that cut across diagnostic categories. Strategies may include pharmacological, psychosocial, device-based, or biologic therapeutic candidates that engage the target of interest. Studies may also evaluate the functional impact of target engagement and off-target effects and determine the optimal parameters (e.g., dose and dosing regimen) needed to achieve functional impact.
  5. Developing novel preventive interventions based on an understanding of risk and protection at the level of the individual and within a developmental and environmental context, and testing whether targeting proximal risk and protective factors, or intervening factors that reduce risk, result in promoting health and preventing illness.

Strategy 3.1.B: Developing and implementing measurement strategies to facilitate mechanism-based intervention development and testing

Interest areas include:

  1. Developing and validating quantitative behavioral and neurophysiological measures of target engagement in humans and animals as translational assays linked to functional domains disrupted in and across mental illnesses.
  2. Developing and optimizing reliable and objective measures of target engagement and intervention on brain (molecular, cellular, circuit) function, side effects, clinical symptoms, and functional outcomes that can be implemented in clinical trials.
  3. Testing novel behavioral markers and their associated neural activity patterns as potential stratification measures. Such testing might include computational and bioinformatics approaches and remote sensors.
  4. Optimizing and validating real world outcome measures, including participant-reported outcomes, for use across clinical and non-clinical populations. Such measures may take into account illness phase, age, sex, race, ethnicity, culture, disability, education, socioeconomic background, and other factors.
  5. Developing and assessing novel mobile technology and digital health tools to enable objective measurement of behavior and intervention effects on symptom expression, functional outcomes, and quality of life in naturalistic environments.
  6. Developing valid proxy measures or markers that are relatively brief and cost-effective for use in outcomes research.
  7. Applying quantitative methods, algorithms, and metrics to assess the value and efficiency of intervention strategies.
  8. Identifying appropriate study designs, methods, and measures for interventions that target upstream (e.g., beyond the individual level) risk and/or protective factors for mental illness, including mental health disparities.

Clinical trials have traditionally focused on diagnostic status and symptom severity. Inattention to the complex topography of intervention targets, and to individual differences in psychopathology and intervention needs and preferences, can limit the value of findings and their potential uptake in routine practice. Strategies should focus on functional outcomes, considered within the context of an individual’s development stage, environment, and culture.

Personalized mental health interventions mean that people should receive preventive and treatment interventions optimally matched to their needs. Optimizing interventions and technologies will not only require consideration of symptoms, phases of illness, and functioning, but also a broader consideration of genetic, developmental, psychosocial, cultural, and environmental factors, and functional deficits and needs. Optimal care will also require consideration of the characteristics of population stratification or the candidate interventions and characteristics of providers and settings. Efficient research designs are needed to examine approaches for optimizing interventions for individuals, families, communities, populations, and settings.

To better tailor existing interventions to optimize outcomes, NIMH will support research that employs the following Strategies:

Strategy 3.2.A Investigating personalized intervention strategies across disease progression, development, and diverse populations

Interest areas include:

  1. Investigating heterogeneity in, and mechanisms of, response to existing efficacious preventive and treatment interventions to inform personalized interventions that address specific outcomes.
  2. Investigating strategies for sequencing or integrating interventions that are optimal for individuals in the context of phases of disease progression, stages of development, and other characteristics.
  3. Establishing the safety and efficacy of therapeutic interventions previously found to be effective in one population and applied to other, understudied populations, such as children, older adults, and women at various phases of the reproductive cycle (including menarche, the menstrual cycle, all stages of pregnancy, and menopause), while testing targets, target engagement, and/or biomarkers of efficacy specific to these populations.
  4. Running prospective studies of known efficacious interventions to identify moderator variables and objective biomarkers, digital phenotypes, composite biomarkers, and/or multi-modality derived biotypes.
  5. Developing multi-modal intervention strategies that combine the simultaneous application of established or novel pharmacological, psychosocial, biologic, and/or neuromodulation interventions to selectively access specific therapeutic targets through synergistic action.

Strategy 3.2.B Developing and refining computational approaches and research designs that can be used to inform and test personalized interventions

Interest areas include:

  1. Developing and refining research methods that can be used to advance personalized interventions, including computational algorithms for prescriptive approaches and innovative trial designs.
  2. Reanalyzing or conducting meta-analyses using individual or aggregated clinical trials, patient registries, electronic health records, or other existing clinical datasets to identify moderators that might serve as tailoring variables for interventions.
  3. Applying innovative computational approaches (e.g., machine learning, artificial intelligence, pattern classification techniques, predictive analytics) to multiple streams of data (e.g., routinely collected standardized measures in electronic health records, sensor-based data, social media/device use metrics, community-level data) using existing data sources to inform targets and timing for interventions and to facilitate clinical decision-making.
  4. Developing and using innovative trial designs and data collection strategies to test personalized strategies that incorporate tailoring variables (e.g., clinical data, biomarkers, behavioral markers derived from passive sensing of naturalistic behaviors, patient response history) into participant assignment.
  5. Promoting research designs that address the needs of certain groups. Such studies may include computational approaches that address biases in the data used to develop models (e.g., systemic under diagnosis in certain racial or ethnic groups) and use gold standard data that are diverse, appropriately over-sampled for certain groups, and that do not train the model to perpetuate existing health disparities.

Effectiveness research aims to generate information about the implementation of interventions and services in real-world settings. Effectiveness research is most useful for informing practice or policy decisions when it addresses a condition that has substantial public health significance; when it justifies the practical benefit of the intervention over existing approaches; when it is conducted in representative populations and contexts; when interventions are potentially scalable and could be disseminated into current practice; and, when it assesses a broad array of outcomes relevant to interested parties.

Effectiveness research is best implemented through efficient and innovative platforms and designs that advance treatment personalization in community settings. Deployment-focused models of intervention and services research, which consider the key characteristics of the settings and providers where interventions and services will be implemented, are critical. Consistent with the NIMH experimental therapeutics approach to intervention development and testing, there is a need for effectiveness trials that contribute to our overall understanding of intervention change mechanisms. Not only are these effectiveness trials beneficial when they test the impact of interventions on clinical endpoints; they are beneficial when they explicitly examine whether the intervention engages the targets that mediate the clinical benefit.

To better test intervention effectiveness in community practice settings, NIMH will support research that employs the following Strategies:

Strategy 3.3.A Developing and testing approaches for adapting, combining, and sequencing interventions to achieve the greatest impact on people’s lives and functioning

Interest areas include:

  1. Developing and testing approaches for implementing new indications and developing and testing adaptations or augmentations of evidence-based interventions when research suggests that a moderator or negative prognostic factor can be targeted to improve response substantially for a readily identifiable refractory subgroup.
  2. Testing integrated and sequenced approaches to optimize effectiveness and safety, while minimizing unnecessary or off-label use of devices or psychotropic medications among children, adolescents, and adults.
  3. Developing and testing broadly relevant preventive/early interventions that target shared modifiable risk and protective factors and/or key domains of functioning (e.g., emotion regulation, cognitive systems, social processes) and thereby change life trajectories and reduce risk for multiple mental illnesses.
  4. Focusing on strategies that address the needs of individuals and populations at risk for relapse/recurrence and manage chronic disorders (e.g., post-acute phase interventions/service strategies that are matched to the stage of illness both in terms of the goals and approaches to maximize the chances of complete recovery and sustained remission).
  5. Developing and testing approaches that employ mobile health (mHealth) and other emerging technologies to boost the effectiveness of evidence-based interventions and to monitor health.
  6. Examining when and how social determinants of health moderate intervention outcomes and identifying opportunities to implement interventions that target modifiable determinants.
  7. Using community-engaged research approaches to ensure that mental health interventions align with the needs of populations that lack access to care; that community members are involved in all phases of research; and, that community-based intervention studies employ rigorous designs to address health disparities questions.

Strategy 3.3.B Conducting efficient pragmatic trials that employ new tools to rapidly identify, engage, assess, and follow participants in the context of routine care and other settings

Interest areas include:

  1. Conducting effectiveness trials that leverage practice-based research and other research investments to inform intervention development and increase the efficiency and relevance of effectiveness research, including identifying targets and optimal timing for intervention.
  2. Supporting refinement of preventive and treatment interventions for mental illnesses, while capitalizing on efficiencies to facilitate participant recruitment and data collection.
  3. Supporting practice-based research aimed at refining and testing efficacious preventive interventions (including universal, selective, indicated, and tiered approaches), so that they are scalable and can be sustainably implemented in settings (e.g., primary care, schools, communities) where preventive services are delivered to youth.
  4. Externally validating practice-based research across diverse populations and contexts to enhance the relevance and translation potential of trial results.

Strategy 3.3.C Enhancing the practical relevance of effectiveness research via deployment-focused, hybrid effectiveness-implementation studies

Interest areas include:

  1. Encouraging deployment-focused intervention and service models and effectiveness testing that consider the perspective of relevant interested parties and key characteristics of intended intervention settings, to increase the likelihood that the interventions/services are feasible and scalable, and the research results will have utility for end users.
  2. Emphasizing hybrid effectiveness-implementation research that goes beyond examining the effect of interventions on symptomatic or functional outcomes and designing studies to address questions regarding how client-, provider-, community-, and organizational-level factors impact clinical outcomes, implementation, and scalability of research-generated interventions.
  3. Encouraging hybrid effectiveness-implementation trials across diverse settings to identify setting characteristics (e.g., workforce capacity, case mix) that impact intervention delivery and test strategies to sustain intervention effectiveness and quality of implementation in diverse settings.
  4. Examining novel applications of technology that can generalize across indications, target populations, and operating platforms to facilitate the delivery of interventions and enhance their reach and therapeutic value.

Progress for Goal 3

Learn about the progress NIMH has made toward Goal 3 of the NIMH Strategic Plan for Research: Strive for Prevention and Cures.

Predictive Models Show Promise in Preventing Suicide
In a study funded by the National Institutes of Health, researchers created new suicide risk prediction models using data in electronic health records from the Indian Health Service.

Integrated Care for Depression Yields Extended Benefits, Malawi Study Shows
An NIMH-funded study showed that incorporating depression treatment into care for chronic health conditions improved well-being for both patients and their families.

Primary Care Can Play Key Role in Suicide Prevention
Adding suicide care practices to routine adult primary care visits reduced suicide attempts by 25% in the months after the visit.

Improving Firearm Safety in Pediatric Primary Care
An automatic reminder supported by low-burden facilitation increased delivery of a universal secure firearm storage program during pediatric primary care.

New Hope for Rapid-Acting Depression Treatment
A new study, funded in part by the National Institute of Mental Health, showed that a new medication derived from ketamine is safe and acceptable for use in humans, setting the stage for clinical trials testing it for hard-to-treat mental disorders like severe depression.

New Gene Delivery Method Paves the Way for Advanced Brain Therapies
A new study, funded in part by the National Institute of Mental Health, describes a promising new gene delivery vehicle that could advance treatment for brain disorders.

Collaborative Care Could Help Reduce Disparities in Mental Health Treatment
In an NIMH-funded study, a comprehensive collaborative care intervention significantly reduced post-traumatic stress disorder (PTSD) symptoms among trauma patients from racial and ethnic minority backgrounds.

Digital Autism Screening Tool Could Enhance Early Identification
A tablet-based screening tool that analyzes children’s behavior in response to specific video clips shows promise for enhancing early autism screening, according to a study supported by NIMH.

Characterizing Childhood Irritability Across Ages and Stages
NIMH-supported research captures expressions of irritability across developmental stages via a clinically relevant measurement tool: the MAPS Temper Loss Scale.

Basic Research Powers the First Medication for Postpartum Depression
Decades of NIMH-supported basic research led to a pioneering treatment for postpartum depression and continues to power exciting advances in women's mental health care.

Gene-Based Therapy Restores Cellular Development and Function in Brain Cells From People With Timothy Syndrome
In a proof-of-concept study, researchers demonstrated the effectiveness of a potential new therapy for Timothy syndrome, an often life-threatening and rare genetic disorder that affects a wide range of bodily systems, leading to severe cardiac, neurological, and psychiatric symptoms as well as physical differences such as webbed fingers and toes.

Novel Treatment Helps Children With Severe Irritability
A new study by NIMH researchers demonstrated the effectiveness, feasibility, and safety of exposure-based cognitive behavioral therapy for severe irritability and temper outbursts in children. The positive results set the foundation to continue exploring exposure therapy as a potential treatment for childhood irritability.

Intervention Reduces Likelihood of Developing Postpartum Anxiety and Depression by More Than 70%
Results from a large clinical trial funded by the National Institutes of Health show that an intervention for anxiety provided to pregnant women living in Pakistan significantly reduced the likelihood of the women developing moderate-to-severe anxiety, depression, or both six weeks after birth.

Cognitive Behavioral Therapy Alters Brain Activity in Children With Anxiety
Researchers at the National Institute of Mental Health found that unmedicated children with anxiety disorders show widespread overactivation in brain functioning and that treatment with cognitive behavioral therapy led to a clinically significant drop in anxiety symptoms and improved brain functioning.

Saving Lives Through the Science of Suicide Prevention
Evidence-based efforts to improve suicide risk screening, assessment, and intervention are helping to save lives, thanks to research supported by NIMH.

Emergency Department Intervention Reduces Adult Suicide Risk
Evidence-based practices for suicide prevention effectively reduced suicidal behaviors among adults seen for care in emergency departments.

Cracking the Ketamine Code
NIMH supported science and NIMH researchers helped pave the way for the development of ketamine—a groundbreaking treatment that has improved the lives of those who are impacted by treatment-resistant depression.

Helping People With Serious Mental Illness Quit Smoking
In a study funded by the National Institute of Mental Health and published in JAMA Psychiatry, Gail Daumit, M.D., of Johns Hopkins University, A. Eden Evins, M.D., of Massachusetts General Hospital and Harvard Medical School, and colleagues developed a tobacco smoking cessation intervention for people with serious mental illness.

RAISE-ing the Standard of Care for Schizophrenia: The Rapid Adoption of Coordinated Specialty Care in the United States
The Recovery After an Initial Schizophrenia Episode research initiative, launched by NIMH to test the effectiveness of coordinated specialty care to treat first-episode psychosis, has transformed the mental health landscape in the United States and helped thousands of people with schizophrenia achieve better outcomes.

Blocking HIV Enzyme Reduces Infectivity and Slows Viral Rebound
In this NIMH-funded study, researchers developed a compound that blocked an enzyme critical for forming HIV particles, which stopped the virus from correctly forming and becoming infectious.

Chatbot Encourages People With Eating Disorders to Seek Care
In a new NIMH-funded study, Ellen Fitzsimmons-Craft, Ph.D., an associate professor of psychiatry at Washington University School of Medicine, and colleagues developed a chatbot to encourage people with eating disorders to connect with care.

Breaking Down Barriers to HIV Medication Access
Researchers investigated whether home delivery of ART for a modest fee could help improve ART access and use, finding it resulted in increased viral suppression in participants compared with clinic-based medication distribution.

Long-acting antiretroviral therapy suppresses HIV among people with unstable housing, mental illnesses, substance use disorder
A long-acting antiretroviral treatment given every four to eight weeks, and delivered with comprehensive support services, suppressed HIV in people who were previously not virologically suppressed.

Brief Cognitive Training May Extend the Antidepressant Effects of Ketamine
An NIMH-supported study suggests that a brief self-association training program can extend the effects of a single ketamine infusion by shifting people’s negative self-beliefs.

Barriers and Supports to HIV Prevention Among Young Women in Keny
In a qualitative study supported by NIMH, researchers identified barriers and supports to Kenyan women’s use of PrEP, a highly effective medication to reduce HIV transmission.

A Clinical Pathway for Suicide Risk Screening in Adult Primary Care
An NIMH-supported workgroup developed an evidence-based screening pathway to help primary care doctors identify adults at risk of suicide and bridge them to critical mental health services.

Study Shows REACH VET Program Effective for Veterans at High Risk for Suicide
A recent NIMH co-authored study shows that a Department of Veterans Affairs suicide prevention program was associated with fewer inpatient mental health admissions and emergency department visits, and a 5 percent reduction in documented suicide attempts.

Mindful Mood Balance Effective for Treating Residual Depressive Symptoms and Suicidal Ideation
NIMH-supported researchers have found an online mindfulness-based cognitive behavioral therapy—called Mindful Mood Balance—is effective at reducing residual depressive symptoms and at reducing suicidal ideation in those who experience these symptoms.

New Approach Allows Magnetic Brain Stimulation to Target Deep Brain Structures
TMS can only directly stimulate the outermost layer of the brain, but NIMH researchers have found that mapping a person’s brain architecture may make it possible to guide TMS to deep brain targets.

Personalizing Deep Brain Stimulation for Treatment-Resistant Depression
A recent NIMH-supported study investigated whether deep brain stimulation could be personalized for individuals with treatment-resistant depression.

Understanding the Characteristics of Suicide in Young Children
Researchers supported by NIMH recently published a study describing the characteristics of suicide in young children and the factors that sometimes precede these tragic events, providing an avenue for future research and intervention.

A New Strength-Focused Framework to Prevent American Indian and Alaska Native Youth Suicide
Researchers have developed a promising new framework for suicide prevention in American Indian and Alaska Native (AI/AN) communities. The research framework expands on conventional risk reduction strategies by placing Indigenous culture, knowledge, beliefs, and community collaboration at the center of the approach.

Researchers Use Exosome-Based Strategy to Block HIV in Mice
In this NIMH-funded study, researchers used exosomes to deliver novel protein into the cells of mice infected with HIV. The protein attached to HIV’s genetic material and prevented it from replicating, resulting in reduced levels of HIV in the bone marrow, spleen, and brain.

Partner Violence and Elevated HIV Viral Load in South African Women
New analysis suggests an association between intimate partner violence and elevated viral loads among postpartum women in South Africa.

Improved Emotion Regulation in Dialectical Behavior Therapy Reduces Suicide Risk in Youth
An analysis of clinical trial data shows that improvements in emotion regulation in youth at high risk for suicide who received dialectical behavior therapy (DBT) led to a reduction in self-harm behaviors.

Assessing Suicide Risk Among Childbearing Women in the U.S. Before and After Giving Birth
NIMH-supported researchers investigated suicide risk among women in the year before and year after giving birth.

Investigating Unintentional Injury as a Risk Factor for Self-Harm
In a recent study, NIMH-supported researchers found that certain types of unintentional injury have stronger associations with self-harm than others in adolescents.

Prototype App for Mobile Devices Could Screen Children at Risk for Autism Spectrum Disorder
A mobile app was successful at distinguishing toddlers diagnosed with autism spectrum disorder (ASD) from typically developing toddlers based on their eye movements while watching videos, according to a study funded by the National Institutes of Health.

NIMH Addresses Critical Need for Rapid-Acting Interventions for Severe Suicide Risk
NIMH is working to meet the urgent need for rapid-acting suicide prevention interventions by supporting research investigating the feasibility and safety of treatment protocols that have the potential to quickly reduce severe suicide risk in youth and adults.

Adaptive Screener May Help Identify Youth at Risk of Suicide
In a study supported by NIMH, researchers have developed a computerized adaptive screener that can help identify youth at risk for attempting suicide.

Using Mobile Technology to Improve Care for Teens with Depression
In a project funded by the NIMH Small Business Technology Transfer program, researchers are investigating whether mobile technology can be used to create a passive monitoring system that can predict teens’ depressive symptoms and improve the quality of their care.

Testing and Refining Biomarkers to Support Intervention Research for Children with Autism
NIMH, along with other NIH Institutes, is supporting the ABC-CT project, a multisite study that aims to test and refine biomarkers that can be used as objective measures of social impairment for children with autism in clinical trials, leading to more predictive and personalized treatment.

Brief Suicide Prevention Interventions in Acute Care Settings May Reduce Subsequent Suicide Attempts
A research project supported by NIMH analyzed multiple studies to determine the effectiveness of brief suicide prevention interventions in acute care settings.

Supporting the Development of Early Autism Screening Tools
NIMH, along with other NIH Institutes, is supporting the goal of identifying autism in the first year of life by funding projects that seek to seek to translate findings related to early-emerging signs of autism into practical ASD screening tools that can be implemented in the general population and community settings.

Transforming Mental Health Care Through ALACRITY
In 2018, 11.4 million adults in the United States experienced a serious mental illness, such as schizophrenia-spectrum disorders, severe bipolar disorder, and severe depression.

Combined Electroconvulsive Therapy and Venlafaxine a Well-Tolerated Depression Treatment for Older Adults
The use of right unilateral ultrabrief pulse (RUL-UB) electroconvulsive therapy (ECT) in combination with the antidepressant venlafaxine to treat depression in elderly patients is well tolerated and results in minimal neurocognitive side effects, according to a new NIH-funded study published in the American Journal of Geriatric Psychiatry.

Identifying Practices for Reducing Incarceration of Those with Mental Illnesses—A Study of “Stepping Up”
According to a 2017 report by the Bureau of Justice Statistics, approximately two-thirds of female inmates in prisons and jails and around a third of men in prisons and jails report having been diagnosed as having mental health disorder by a mental health professional.