Full Text PA-92-94


NIH GUIDE, Volume 21, Number 26, July 17, 1992

PA:  PA-92-94

P.T. 04

  Health Services Delivery 
  Mental Disorders 

National Institute of Mental Health


The National Institute of Mental Health (NIMH) announces the
availability of support for Centers for Research on Services for People
with Severe Mental Disorders.  The purpose of these Centers is to
promote, develop, and conduct multidisciplinary research to improve the
organization, financing, delivery, quality, effectiveness, and outcomes
of mental health services for persons with severe and persistent mental

This Program Announcement (PA) addresses one of the major
recommendations set forth in "Caring for People with Severe Mental
Disorders:  A National Plan of Research to Improve Services"
(Department of Health and Human Services Pub. No. (ADM)91-1762), which
may be obtained through the Superintendent of Documents, Government
Printing Office, Washington DC 20402-9325 (telephone 202-783-3238).  It
also complements the NIMH PA, Implementation of Caring for People with
Severe Mental Disorders:  A National Plan of Research to Improve
Services, (PA-92-65), which invites applications for research project
grants, research demonstrations, and career development applications in
support of this National Plan and can be obtained from the National
Institute of Mental Health, Room 9-95, 5600 Fishers Lane, Rockville MD
20857; telephone 301-443-4673.


The Public Health Service (PHS) is committed to achieving the health
promotion and disease prevention objectives of "Healthy People 2000,"
a PHS-led national activity for setting priority areas.  This PA,
Centers for Research on Services for People with Severe Mental
Disorders, is related to the following objectives set forth in "Healthy
People 2000:  National Health Promotion and Disease Prevention
Objectives:" objective 6.4, reduce the prevalence of mental disorders
among adults living in the community to less than 10.7 percent);
Objective 6.6, increase to at least 30 percent the proportion of people
aged 18 and older with severe, persistent mental disorders who use
community support programs; Objective 6.7, increase to at least 45
percent the proportion of people with major depressive disorders who
obtain treatment; Objective 6.8, increase to at least 20 percent the
proportion of people aged 18 and older who seek help in coping with
personal and emotional problems; and objective 6.12, establish mutual
help clearinghouses in at least 25 States.  Potential applicants may
obtain a copy of "Healthy People 2000" (Full report:  Stock No.
017-001-00474-0) or "Healthy People 2000" (Summary report:  Stock No.
017-001-00473-1) through the Superintendent of Documents, Government
Printing Office, Washington Office, Washington, DC 20402-9325
(telephone 202-783-3238).


Applications may be submitted by domestic and foreign for-profit and
non-profit organizations, public and private, such as universities,
colleges, hospitals, laboratories, units of State and local
governments, and eligible agencies of the Federal Government.
Applications from minority individuals and women are encouraged.


This PA will use the National Institutes of Health (NIH) Specialized
Center (P50) mechanism.  Responsibility for the planning, direction,
and execution of the proposed project will be solely that of the
applicant.  The total project period for applications submitted in
response to the present PA may not exceed five years.


The funding cap for a Center for Research on Services for People with
Severe Mental Illness is $500,000 per year, plus negotiated
institutional indirect costs.  Applications requesting direct costs in
excess of this amount will be returned to the applicant without review.

It is anticipated that up to three new awards may be made in FY 93.
This level of support is dependent on the receipt of a sufficient
number of applications of high scientific merit.  Although this program
is provided for in the financial plans of the Institute, awards
pursuant to this PA are contingent upon the availability of funds for
this purpose.


Millions of Americans suffer from severe, persistent, and disabling
mental disorders that can devastate their lives and the lives of those
around them.  The nature of these illnesses is such that those who
suffer from them often have pervasive difficulty maintaining good
physical health, coping with the tasks of daily living, finding and
retaining work, fulfilling homemaking responsibilities, and forming and
sustaining social relationships.
Because severe mental illnesses are associated with disturbances in
thinking and behavior, these disorders have been the subject of much
misunderstanding in the past. Fortunately, there is now widespread
recognition that mental illnesses are true illnesses.  As in the case
of physical illnesses, it is possible through research to develop
improved treatments and services that can attend more effectively to
the needs that persons with severe mental illness have for medical
treatment and to their care, social support, rehabilitation, housing,
and enhanced quality of life.

Mental health services research is still an underdeveloped field.  To
focus attention on this problem and develop a remedial strategy, NIMH
convened three panels of experts to prepare Caring for People with
Severe Mental Disorders:  A National Plan of Research to Improve
Services.  The Clinical Services Research Panel considered areas
ranging from diagnosis to outcome assessment, with a major focus on
improving the quality of clinical care and evaluating the impact of
clinical services.  The Service Systems Research Panel focused on
structures and processes of mental health service delivery, ranging
from the organization and financing of services to legal issues and
society's attitudes towards the mentally ill.  The Research Resources
Panel addressed the infrastructure needed to implement the substantive
recommendations of the other two panels.

This announcement responds to a recommendation of the Research
Resources Panel that NIMH expand and increase its support for
multidisciplinary mental health services research centers.  These
centers are needed to provide stimulating and productive environments
in which investigators from fields of services research, clinical
science, economics, public health, and behavioral and sociocultural
science can interact and direct their energies toward the
conceptualization and development of studies to improve services for
persons with severe mental illness.

In keeping with the scope of the national plan which this announcement
is intended to help implement, applications submitted in response to
this announcement should focus their proposed research on services for
adult (including elderly) persons with severe mental disorders.
Although some limited support may be requested under this announcement
for research on children and adolescents, support for services research
in this area is available under two other NIMH program announcements.
For greater detail on the specifics of funding for child and adolescent
mental health services research, please refer to the NIMH program
announcements "Implementation of the National Plan for Research on
Child and Adolescent Mental Disorders" (PA-91-46), April 1991, which
solicits research grant applications to expand the full spectrum of
research related to child and adolescent mental disorders, and "Centers
for Research on Mental Health Services for Children and Adolescents"
(PA-92-22), which solicits center grant applications to develop
multidisciplinary research that can help to improve the organization,
financing, delivery, effectiveness, and outcomes of mental health
services for children and adolescents.  Copies can be obtained from the
National Institute of Mental Health, Room 9-95, 5600 Fishers Lane,
Rockville MD 20857, telephone: 301-443-4673.

Research Issues

Examples of the types of services research issues that might be
addressed by a Center are listed below.  The list is illustrative
rather than comprehensive.  It is expected that additional relevant and
important research topics will be identified by investigators
responding to this announcement.

Studies of the prevalence of severe mental disorders (including
co-occurring substance abuse disorders) in various types of service

Research on clinical and related services provided to persons with
severe mental disorders by mental health professionals in different
types of service settings, including accuracy of diagnoses,
appropriateness of treatments, quality of care, costs, and short- and
long-term outcomes for patients and their families

Studies of mental health services for persons with severe mental
disorders provided by general health care personnel in various
settings, including accuracy of diagnoses, clinical appropriateness of
treatments, quality of care, and outcomes

Research on the effectiveness of consultation/liaison psychiatric
services for persons with severe mental disorders in general health
care settings

Studies of emergency mental health services for persons with severe
mental disorders

Research on the organization and financing of services for persons with
severe mental disorders including burden on families and State and
local governments, costs of services, and impacts of different
financing mechanisms

Studies of the cost-effectiveness of services for persons with severe
mental disorders in various settings, including new and alternative
types of services and case management Research on cost-containment
strategies in mental health care (e.g., managed care, capitated care,
contracted care) and the trade-offs between cost-savings from managed
care (and similar cost-containment strategies) and the quality of care
provided under managed care in comparison with that under non-managed

Research on coordination and integration of mental health services and
other types of services (e.g., housing, health, income support,
vocational and psychosocial rehabilitation, and legal services) needed
to maintain individuals with severe mental disorders in the community
at various stages of illness, including research on models of state
consolidated funding for an appropriate continuum of services

Studies of disabilities and functional capabilities of persons with
severe mental illness at various stages of illness

Research on rehabilitation services for persons with severe mental

Investigations of the integration of public and private services,
resources, and reimbursement mechanisms

Studies of services for persons with co-occurring severe mental
disorders, substance abuse, and physical health disorders

Research on services for elderly persons with Alzheimer's disease,
related dementias, and other severe mental disorders, including
services provided in nursing homes and other residential care settings

Studies of self-help programs, groups, and organizations for persons
with severe mental illness

Research on ways to assist families in caring for persons with severe
mental disorders, including assessment of family burden and
appropriateness and effectiveness of family education programs and
family support programs

Research on services for persons with severe mental disorders in jails
and prisons

Studies of the impact of various mental health laws, civil rights
legislation (e.g., Americans with Disabilities Act of 1990), and
relevant administrative regulations (e.g., inpatient and outpatient
civil commitment, conservatorship and guardianship statutes, provisions
pertaining to issues of right to treatment, as well as the right to
refuse treatment, etc.) on delivery and effectiveness of mental health

Research to test the validity and reliability of currently used outcome
measurement research instruments, particularly for measuring outcomes
among persons with severe mental illness who are members of ethnic
minorities or who are impoverished

Research on the development, adaptation, and application of advanced
analytic methods to mental health services research

Research on development of methodology for mental health services

Program Specifications

A Center should be planned and organized for the purpose of addressing
major gaps in scientific knowledge and needs in the field of mental
health services research on people with severe mental disorders.
Centers must be multidisciplinary, including investigators from
disciplines such as psychiatry, psychology, social work, nursing,
epidemiology, biostatistics, economics, sociology, public health, law,
and political science.

The Principal Investigator will serve as Director of the Center and
provide scientific and administrative leadership by devoting at least
50 percent of his/her time to the Center, including time spent on
Center research projects that are clearly related to and supportive of
the overall Center plan for research on services for people with severe
mental disorders.  The Center Director must be responsible for the
planning, coordination, and efficient operation of the Center program,
preparation of the budget, control of expenditures, staff appointments,
and space allocation. Another individual may be designated to be
responsible for the day-to-day administration of the Center.

Each Center should clearly define a cohesive set of research core areas
that will be addressed by Center study teams.  This selection should be
justified on the basis of the public health significance of the issues
to be addressed, the current state of scientific knowledge, the
feasibility of doing research in the designated areas (e.g.,
availability of measurement instruments and populations to study), and
the potential impact of the research for advancing understanding and
assisting improvement of mental health services for those with severe
mental disorders.  The plan for each research core area must be clearly
defined for the entire period of support requested.

Center costs may include salary of core personnel, including the Center
Director, research expenses, and research resources shared across
Center projects such as statistical consultation, data storage and
analysis, and equipment.  Support may also be provided for
developmental studies that involve conceptualizing services research
problems and research approaches, establishing relationships with
service providing agencies and policy makers, developing and refining
research instruments, analyzing mental health system data, and
conducting small-scale exploratory and developmental research.  It is
expected that these Center activities will lead to independent
proposals submitted to NIMH and other agencies by Center investigators
for independently funded research projects (e.g., R01s) on mental
health services for those with severe mental disorders.

If a proposed Center is to be located in a university, research
institute, mental health agency, or other larger organization, the
prospective organizational, administrative, and managerial
relationships between the proposed Center and the host organization
must be addressed.  Each Center is expected to have an administrative
structure that will contribute to efficient operation, sound financial
practices, and effective use of available resources.

Applicants from institutions which have another research center (e.g.,
a health services research center) may wish to identify this center as
a resource for conducting the proposed research.  In such a case, a
letter of agreement from the program director or principal investigator
should be included with the application.

While a Center should be involved in attracting new investigators into
the field of mental health services research, funds from the Center may
not be used to support training activities other than those incidental
to the conduct of specific research projects.  Centers may apply to
NIMH for separate research training funds available under the National
Research Service Award Program of the U.S. Public Health Service.

Public-Academic Liaison

As part of the NIMH Public-Academic Liaison (PAL) initiative, special
encouragement is given to applications that involve active
collaborations between academic researchers and public sector agencies
in planning, undertaking, analyzing, and publishing research pertaining
to people with severe mental disorders.  The PAL initiative is based
upon the premise that important new advances in the understanding and
treatment of severe mental illness can result from improved linkages
between the Nation's scientific resources and the public sector
agencies and programs in which many people with severe mental disorders
receive their care.  The scope of the PAL initiative encompasses public
sector agencies of all types that provide services for people with
severe mental disorders.



Applications for grants and cooperative agreements that involve human
subjects are required to include minorities and both genders in study
populations so that research findings can be of benefit to all persons
at risk of the disease, disorder, or condition under study; special
emphasis should be placed on the need for inclusion of minorities and
women in studies of diseases, disorders, and conditions which
disproportionately affect them.  This policy applies to all research
involving human subjects and human materials, and applies to males and
females of all ages.  If one gender and/or minorities are excluded or
are inadequately represented in this research, particularly in proposed
population-based studies, a clear compelling rationale for exclusion or
inadequate representation should be provided.  The composition of the
proposed study population must be described in terms of gender and
racial/ethnic group, together with a rationale for its choice.  In
addition, gender and racial/ethnic issues should be addressed in
developing a research design and sample size appropriate for the
scientific objectives of the study.

Applicants are urged to assess carefully the feasibility of including
the broadest possible representation of minority groups.  However, NIH
and ADAMHA recognize that it may not be feasible or appropriate in all
research projects to include representation of the full array of United
States racial/ethnic minority populations (i.e., American Indians or
Alaskan Natives, Asians or Pacific Islanders, Blacks, Hispanics).
Investigators must provide the rationale for studies on single minority
population groups.

Applications for support of research involving human subjects must
employ a study design with minority and/or gender representation (by
age distribution, risk factors, incidence/prevalence, etc.) appropriate
to the scientific objectives of the research.  It is not an automatic
requirement for the study design to provide statistical power to answer
the questions posed for men and women and racial/ethnic groups
separately; however, whenever there are scientific reasons to
anticipate differences between men and women, and racial/ethnic groups,
with regard to the hypothesis under investigation, applicants should
include an evaluation of these gender and minority group differences in
the proposed study.  If adequate inclusion of one gender and/or
minorities is impossible or inappropriate with respect to the purpose
of the research, because of the health of the subjects, or other
reasons, or if in the only study population available, there is a
disproportionate representation of one gender or minority/majority
group, the rationale for the study population must be well explained
and justified.

The NIH/ADAMHA funding components will not make awards of grants or
cooperative agreements that do not comply with this policy.  For
research awards  covered by this policy, awardees will report annually
on enrollment of women and men, and on the race and ethnicity of

Protection of Human Subjects

The Department of Health and Human Services has regulations for the
protection of human subjects and has developed additional regulations
for the protection of children.  A copy of these regulations (45 CFR
46, Protection of Human Subjects) and a copy of those pertaining
specifically to children are available from the Office of Protection
from Research Risks, National Institutes of Health, Building 31, Room
5B59, Bethesda, Maryland 20892, telephone (301) 496-7041.  Specific
questions concerning protection of human subjects in research may be
directed to NIMH staff members listed under INQUIRIES.


Applicants are to use the Public Health Service research grant
application form PHS 398 (rev. 9/91).  The number and title of this
announcement, PA-92-94, Centers for Research on Services for People
with Severe Mental Disorders, must be typed in item number 2a on the
face page of the PHS 398 application form.

Applications for a Center grant must include:  (1) an overall
organizational and research plan, and (2) separate, more detailed plans
for the research core areas that are proposed as foci for Center
activity.  For purposes of the page limitations of sections 1 through
4 of PHS 398, the overall Center research plan and organizational plan
should be considered one component with a 25-page limit.  A maximum of
25 additional pages may be used for each research core area that the
Center will address.

Center Organizational and Research Plan:  Each Center must describe an
overall organizational and research plan for the requested period of
support.  The organizational plan must describe the administrative
organization, including its relationship to the applicant institution,
and arrangements for planning, coordinating, and evaluating the Center
program.  Relationships with public mental health systems, and with
other entities (e.g., research institutes, departments of psychiatry
and behavioral science, State Mental Health Authority, educational or
correctional organizations) must be described.  The applicant must
submit (as an appendix to the application) a letter of agreement signed
by the responsible officer of each associated organization, stating
that cooperation, research facilities, services, or other relevant
assistance will be available on a continuing basis.  Appropriate
clearances from each associated organization must be submitted that
state that the proposed research meets that institution's research
review requirements (e.g., Institutional Review Board responsible for
activities involving human subjects).

The research part of the overall Center plan must include a section
that specifies and justifies the cohesive and parsimonious set of
research core areas that will be addressed by Center study teams, the
overall goals and objectives of the Center, the principal areas of
research to be emphasized in the Center, major theoretical and policy
orientations that will guide the Center, the disciplines to be
included, and the plans for coordination among the various research
activities of the Center.  In addition, a statement of relevant current
and pending research, training, and service grant support for
investigators associated with the Center must be included.

Research Core Areas:  For purposes of this announcement, a research
core area is defined as an important area for services research within
which a Center plans to develop and conduct interrelated research
projects.  Since services research is inherently interdisciplinary,
projects within a core area should seek to incorporate collaborative
relationships among scholars representing complementary disciplines.
Separate descriptions must be provided for each major research core
area, including summary descriptions of individual developmental
research projects to be supported in each core area and how these
projects will relate to and support each other.  These descriptions
should cover the relevant literature and existing knowledge; objectives
and significance of the research; research design; proposed study
samples; research investigators and estimated percentages of effort;
budget; and timetable for project implementation.

Budget:  Budgets for the Center core and for each research core area
must be presented in aggregate as well as separately.  Additionally,
the applicant institution must indicate in specific terms its cash and
in-kind support for the Center.  In-kind support should be significant
and may include such items as administrative support, equipment, and
time contributions of institutionally supported researchers and
research assistants who will participate in the Center.

Application Kits:  Application kits containing the necessary forms may
be obtained from business offices or offices of sponsored research at
most universities, colleges, medical schools, and other major research
facilities.  If such a source is not available, the following office
may be contacted for the necessary application material:

Grants Management Branch
National Institute of Mental Health
5600 Fishers Lane, Room 7C-05
Rockville, MD  20857
Telephone:  (301) 443-4414

The signed original and five legible copies of the completed
application must be sent or delivered to:

Division of Research Grants
National Institutes of Health
Westwood Building, Room 240
Bethesda, MD  20892**


Applications will be reviewed for scientific and technical merit by an
initial review group (IRG) of a funding component composed primarily of
non-Federal scientific experts.  Final review is by the appropriate
National Advisory Council; review by Council may be based on policy
considerations as well as scientific merit.  By law, only applications
recommended for consideration for funding by the Council may be
supported. Summaries of IRG discussions are sent to applicants as soon
as possible following IRG review.

Review Criteria

o  Criteria for scientific/technical merit review of Center
applications will include:

o  Relevance of the proposed Center Research program to the public
health goals of this announcement

o  Extent to which the stated goals of the Center and its proposed
projects reflect an understanding of current needs for research on
services for people with severe mental disorders, and the extent to
which these goals are achievable and realistic

o  Scientific leadership and commitment of the Center Director, and
his/her ability to devote adequate time to coordination of the Center

o  Demonstrated scientific and technical capability, experience, and
level of commitment of the proposed research staff

o  Adequacy of representation of the multiple disciplines important for
mental health services for the severely mentally ill, and adequacy of
arrangements to produce collaboration and cooperation among
investigators from various disciplines

o  Adequacy of the Center's leadership, management systems, and
organizational structure to carry out successfully the proposed program
of research and research development

o  Adequacy of coordination and interrelations among individual
research core areas and the core unit

o  Quality of summary descriptions of developmental research projects
within Center research core areas, including coverage of relevant
literature and existing knowledge, research design, adequacy of
proposed study samples, instrumentation, staffing, budget, and
timetable for project implementation

o  Potential of the Center program to generate high-quality
applications for additional research support through mechanisms such as
small grants, First Independent Research Support and Transition (FIRST)
awards, and research project awards

o  Extent of institutional support and commitment to the proposed
research program

o  Linkages to a major public mental health system serving those with
severe mental disorders

o  Potential contribution of the planned Center program to improving
mental health services for people with severe mental disorders

o  Relevance of proposed research to minorities and women

o  Adequacy of facilities, institutional support, general environment,
core resources, and collaborative relationships

o  Evidence of cooperation and commitment from persons and
organizations whose support is essential for the conduct of the
proposed research

o  Adequacy of plans to protect research participants

o  Appropriateness of requested budget in relation to proposed Center

Receipt and Review Schedule

Applications will be reviewed once a year according to the following
review schedule:  receipt date -- October 1 (November 1 for competing
continuations, supplemental, and revised applications); initial review
-- February/March; Advisory Council review -- May/June; earliest start
date -- July 1.  Applications received after the given receipt date
will be returned to the applicant without review.


Preference will be given to projects consistent with the NIMH
Public-Academic Liaison initiative (bringing together public sector
service providers and academic researchers) and to projects involving
special populations (e.g., minorities, women, those living in rural
areas, impoverished and homeless persons).

Factors considered in determining which applications will be supported
include quality as determined by IRG and Council recommendations, NIMH
program needs and priorities, and availability of funds.


NIMH staff are available for consultation in advance of or during the
process of preparing an application.  Potential applicants should
contact NIMH as early as possible for information and assistance in
initiating the application process and developing an application.

Inquiries may be directed to:

Thomas L. Lalley, M.A., Chief
Kathryn M. Magruder, M.P.H., Ph.D., Assistant Chief
Services Research Branch
Division of Applied and Services Research
National Institute of Mental Health
Parklawn Building, Room 18C-14
5600 Fishers Lane
Rockville, MD  20857
Telephone:  (301) 443-3364

Services Research Branch
Division of Applied and Services Research
National Institute of Mental Health
Parklawn Building, Room 18C-14
5600 Fishers Lane
Rockville, MD  20857

For further information on grants management issues, applicants may

Stephen J. Hudak
Chief, Grants Management Section
National Institute of Mental Health
Room 7C-23 Parklawn Building
5600 Fishers Lane
Rockville, MD  20857
Telephone:  (301) 443-4456


Under the authority of Section 301 of the Public Health Service Act (42
U.S.C. 241), as amended, and subject to availability of funds, the
National Institute of Mental Health will accept applications in
response to this announcement under the receipt dates indicated herein.
Grants must be administered in accordance with the PHS
Grants Policy Statement (Rev. October 1990).  Federal Regulations at 42
CFR Part 52, "Grants for Research Projects," and 45 CFR Parts 74 and 92
concerning administration of grants, are applicable to these awards.
This announcement is not subject to the intergovernmental review
requirements of Executive Order 12372, as implemented through DHHS
regulations at 45 CFR Part 100.  This program is described in the
Catalog of Federal Domestic Assistance 93.242, Mental Health Research


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