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National Institute of Mental Health (NIMH)

The National Institute of Mental Health intends to promote a new initiative by publishing a Funding Opportunity Announcement (FOA) to solicit applications for research on effectiveness and implementation research for post-acute interventions to optimize long-term mental health outcomes in low- and middle-income countries.

This Notice is being provided to allow potential applicants sufficient time to develop meaningful collaborations and responsive projects.

The FOA is expected to be published in October, 2021 with an expected application due date in December, 2021.

This FOA will utilize the R34 activity code. Clinical trials will be optional. Details of the planned FOA are provided below.

The current structure of health systems in low- and middle-income countries (LMIC; see fiscal year 2022 World Bank designations) may prevent the dissemination of post-acute interventions for mental illness. Low levels of public investment in mental health in LMICs are associated with a shortage of mental health providers and facilities. Compared to high-income countries where most public investments are allocated to outpatient care models, low-income and upper-middle-income countries respectively invest 99% and 86% of their public expenditures on hospital-based models. These allocations impact the availability of outpatient and post-acute mental health services, including pharmacological and psychosocial interventions.

Research Scope and Objectives

The NIMH Center for Global Mental Health Research intends to issue an initiative to support developmental research projects to assess the effectiveness and implementation of therapeutic and services interventions for the post-acute phase management of mental health conditions affecting children, youth, adults, and older adults in LMICs. Studies are expected to be executed in an LMIC. Through this initiative, investigators will be expected to generate new information concerning the structure of the health system and changes that may be necessary to facilitate the dissemination (scaling-up and sustainability) of such interventions. Pilot clinical trial studies may assess such facilitators and barriers whereas non-clinical trial studies may derive these from secondary data.

Across conditions, post-acute phase interventions/service strategies are needed that match the stage of illness in terms of both the focus (e.g., consolidating and maintaining gains from acute treatment, managing residual symptoms/impairment, preventing relapse, restoring community functioning, promoting adherence and appropriate service use) and intensity/burden, in order to ensure that the interventions are not only relevant and effective but also acceptable and sustainable for promoting optimal longer-term outcomes. Task-sharing (task-shifting) approaches may be utilized in the proposed study. Technology-assisted approaches might be especially useful for facilitating post-acute phase monitoring, for delivering interventions (e.g., maintenance therapy, relapse prevention), and for promoting treatment engagement/adherence and appropriate service use.

All research applications will be expected to identify valid and reliable ways to (i) identify health system arrangements, such as incentives, regulations, and policies, which may facilitate or deter the availability (supply) and accessibility of the studied post-acute intervention and (ii) identify relevant approaches to measure or extract existing data regarding these arrangements. Applicants will also be expected to outline the planning and/or involvement of key stakeholders related to implementation (e.g., representatives of patients, policymakers, and local institutions) where appropriate.

For applications proposing a single PD/PI, the PD/PI will be required to have a primary academic appointment in an LMIC institution. Applications proposing MPIs will be required to include at least one PD/PI who has a primary academic appointment in an LMIC institution. Research projects must be conducted in the LMIC in which the single PD/PI or at least one PD/PI has a primary appointment. Prospective applicants should plan accordingly.

Examples of relevant research topics include but are not limited to:

• The design and testing of feasibility and acceptability of innovative implementation studies of outpatient or community evidence-based pharmacological and psychosocial interventions for the sustained post-acute care of common mental disorders or serious mental illnesses
• The role of interventions to address social determinants of health (including but not limited to housing, healthy food, water, education, and employment) as a component of psychosocial interventions for post-acute care
• The identification of underlying targets/mechanisms that can aid in the understanding of causal pathways between post-acute service utilization and mental health functioning
• The planning and pilot testing of efficacy, effectiveness, and implementation studies of pharmacological and/or psychosocial evidence-based interventions for adults or children in humanitarian settings
• Assess the availability and test the use of routinely collected data within healthcare networks/EHRs to examine population-level strategies for monitoring, prompting engagement (e.g., care manager check-ins), and promoting appropriate mental health service use for post-acute care
• The development and testing of innovative strategies or interventions for initiating preventive interventions among children and youth treated for gateway conditions (e.g., ADHD, trauma-disorders, anxiety, first-episode psychosis) in order to reduce the risk for common downstream comorbidities (e.g., substance use disorders, suicidality, depression)
• Investigations to study adaptations of successful implementation of effective interventions for the sustained post-acute care and community reintegration of people with common mental disorders to LMIC environments including assessment of feasibility and acceptability
• Exploration of technology-assisted self-monitoring or passive monitoring to detect clinical deteriorations or problematic adherence combined with prompts for self-management strategies or more intense services (e.g., via a patient-clinician/care provider interface or portal)
• Development and pilot testing empirically informed transition planning strategies to facilitate community reintegration, promote continuity of care, and prevent re-hospitalization following inpatient or residential treatment
• Pilot studies to maximize coordination, partnerships, and effective communication between hospital and outpatient-based care systems on post-acute monitoring, interventions, and services

Technical Assistance Teleconference

The NIMH Center for Global Mental Health Research plans to host a technical assistance teleconference via Zoom for potential applicants on October 19, 2021, at 9:00 AM ET. Further information about this teleconference will be provided in the FOA.

Applications are not being solicited at this time.

Please direct all inquiries to:

Leonardo Cubillos, MD, MPH
National Institute of Mental Health (NIMH)
Email: leonardo.cubillos@nih.gov

Holly Campbell-Rosen, PhD
National Institute of Mental Health (NIMH)
Email: holly.campbell-rosen@nih.gov