NIH GUIDE, Volume 22, Number 45, December 17, 1993

PA NUMBER:  PA-94-018

P.T. 34


  Health Care Economics 

  Emotional/Mental Health 

  Health Services Delivery 

National Institute of Mental Health


The purpose of this program announcement is to encourage

investigator-initiated research on mental health economics in order

to advance the scientific knowledge base in this field and assist in

the development of improved strategies for financing and reimbursing

mental health services.  The research invited under this program

announcement is also intended to maintain and increase the

contribution of applied economic research to the development and

analysis of plans for the mental health component of various local,

State, and national level health care reform proposals.


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,

Research on Mental Health Economics, is related to the priority area

of mental health and mental disorders.  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, DC 20402-9325 (telephone 202-783-3238).


Applications may be submitted by foreign and domestic, 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.

Foreign institutions are not eligible for First Independent Research

Support and Transition (FIRST) (R29) awards and Research Program

Projects (P01).  Applications from minority individuals and women are



Research support may be requested through applications for a regular

research grant (R01), small grant (R03), First Independent Research

Support and Transition (FIRST) award (R29), Multi-Institutional

Collaborative Research Project (R10), program project grant (P01),

Investigator-Initiated Interactive Research Project Grant (IRPG),

research demonstration (R18), and Research Infrastructure Support

Program (RISP).

Funds may not be used to establish or operate a treatment,

rehabilitation, or other service program, except in the case of a

research demonstration grant (R18).

Announcements including special requirements regarding eligibility

for the small grants program (R03), FIRST awards (R29),

Multi-Institutional Collaborative Research Project program (R10), and

Investigator-Initiated Interactive Research Project Grant (IRPG) are

available from the National Institute of Mental Health, 5600 Fishers

Lane, Room 9-95, Rockville, MD 20857, telephone 301/443-4673.

Because the nature and scope of the research proposed in response to

this announcement will vary, it is anticipated that the size of the

awards will also vary.

Applications may request support for up to five years for regular

research and research demonstrations.  Annual awards will be made,

subject to continued availability of funds and progress achieved.  A

competing continuation (renewal) application for an R01 may be

submitted near the end of an approved period of support in order to

request funds for continuation of the project.  Small grants are

limited to two years and may not be renewed.  FIRST Awards are for

five years but are not renewable.



Approximately 10 percent of the total national health care

expenditures are spent on treating mental disorders.  However, many

Americans with mental illnesses find that appropriate treatment is

inaccessible because they lack insurance coverage or the insurance

they have for mental illness is inadequate.

Recent efforts to reform the health care system have stressed the

need to expand the field of mental health economics research.  The

National Institute of Mental Health (NIMH) has broadened its interest

in supporting high-quality policy relevant research on the economics

of mental health to find more efficient and equitable mechanisms of

financing mental health care for people with mental disorders and to

prepare for various scenarios of health care reform.

Health care reform provides a unique opportunity to strengthen the

field of mental health economics research.  There is an urgent need

to increase the number of mental health economists and the capacity

of other mental health services researchers to conduct studies

relevant to health care reform.  It is expected that scientific

findings produced by grants submitted in response to this

announcement will ensure that the mental health field will continue

to play an integral and compelling role in the national debate on

mental health care benefit options in health care reform initiatives.


Researchers are encouraged under this program announcement to develop

rigorous research designs for the exploration of important research

topics in mental health economics.  The following areas of research

are illustrative of issues that may be proposed under this program

announcement.  The examples provided are not meant to be exhaustive,

and it is anticipated that other types of important studies will be

proposed by researchers who respond to this announcement.

Cost of Illness.  Cost of mental illness studies assist policy makers

in setting priorities in medical research and mental health care

services development.  An example of such studies is the estimation

of the total economic impact of specific mental disorders, including

the direct costs of treatment of patients suffering from these

illnesses and the indirect costs associated with loss of earnings due

to reduced or lost productivity.

Cost-effectiveness.  There is an increasing awareness that if a

mental health treatment is to be adopted into mainstream clinical

practice, cost-effectiveness needs to be addressed.  Examples of

studies in this area include cost-benefit, cost-effectiveness, and

cost-utility analysis of innovative treatment methods (including new

treatment methods for children and adolescents), systems of care, and

new financing mechanisms for mental disorders.

Health Insurance.  Insurance benefit studies provide important

insight into how covered services are meeting the medical treatment

needs of the mentally ill and how such benefit programs affect the

patients, the providers, and the payers of mental health care.

Examples of research topics include effects of specific insurance

coverage restrictions on access to and delivery of mental health

care, and analysis of the impact of cost-containment strategies

(including managed mental health care and capitation experiments) on

outcome and quality of mental health care.

Financing of Services.  Research is needed on financing of public and

private mental health services or systems and how financing policies

govern resource allocation, access to services, and quality of mental

health care.  Examples of such studies include analysis of strategies

and mechanisms employed by State mental health agencies and other

public agencies for financing services for the severely mentally ill

and analysis of private sector financing of mental health services.

Payment Mechanisms.  Payment mechanisms influence the delivery,

accessibility, use, cost, and quality of mental health services.

Examples of such studies include studies on health care reform

initiatives, including competition in the mental health care system

and analysis of privatization of publicly provided mental health


Methodological Research.  Research is encouraged that will develop

and test the application of new methods of economic analysis in

mental health services research.  Examples of such research may

include development of risk-adjusted capitation rates, risk sharing,

and reinsurance mechanisms and development of simulation models that

advance understanding of the financing of system-wide linkages in

mental health care.





NIH policy is that applicants for NIH clinical research grants and

cooperative agreements will be required to include minorities and

women 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 is

intended to apply to males and females of all ages.  If women or

minorities are excluded or inadequately represented in clinical

research, particularly in proposed population-based studies, a clear

compelling rationale should be provided.

The composition of the proposed study population must be described in

terms of gender and racial/ethnic group.  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.  This information should be included in the form PHS 398

in Sections 1-4 of the Research Plan AND summarized in Section 5,

Human Subjects.

Applicants are urged to assess carefully the feasibility of including

the broadest possible representation of minority groups.  However,

NIH recognizes 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., Native

Americans (including American Indians or Alaskan Natives),

Asian/Pacific Islanders, Blacks, Hispanics).

The rationale for studies on single minority population groups should

be provided.

For the purpose of this policy, clinical research includes human

biomedical and behavioral studies of etiology, epidemiology,

prevention (and preventive strategies), diagnosis, or treatment of

diseases, disorders or conditions, including but not limited to

clinical trials.

The usual NIH policies concerning research on human subjects also

apply.  Basic research or clinical studies in which human tissues

cannot be identified or linked to individuals are excluded.  However,

every effort should be made to include human tissues from women and

racial/ethnic minorities when it is important to apply the results of

the study broadly, and this should be addressed by applicants.

For foreign awards, the policy on inclusion of women applies fully;

since the definition of minority differs in other countries, the

applicant must discuss the relevance of research involving foreign

population groups to the United States' populations, including


If the required information is not contained within the application,

the application will be returned.

Peer reviewers will address specifically whether the research plan in

the application conforms to these policies.  If the representation of

women or minorities in a study design is inadequate to answer the

scientific question(s) addressed AND the justification for the

selected study population is inadequate, it will be considered a

scientific weakness or deficiency in the study design and will be

reflected in assigning the priority score to the application.

All applications for clinical research submitted to NIH are required

to address these policies.  NIH funding components will not award

grants or cooperative agreements that do not comply with these


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 those pertaining specifically

to children are available from the Office of Protection from Research

Risks, National Institutes of Health, Bethesda, MD 20892, telephone



Applicants are to use the research grant application form PHS 398

(rev. 9/91).  The PA number and the title of this announcement must

be typed in item number 2a on the face page of the PHS 398

application form.

Applicants must also specify which support mechanism they are

applying under, e.g., FIRST, small grant, R10.

A limit of 25 pages applies to Sections A through D for R01 and R29

grant applications.  For small grant applications, there is a limit

of 10 pages.  Applications exceeding the specified page limits will

be returned.

Applicants should note that FIRST (R29) applications must include at

least three sealed letters of reference attached to the face page of

the original application.  FIRST applications submitted without the

required number of reference letters will be considered incomplete

and will be returned without review.

Application kits containing the necessary forms may be obtained from

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 exact, clear, single-sided photocopies

of the completed application must be sent to:

Division of Research Grants

National Institutes of Health

Westwood Building, Room 240

Bethesda, MD  20892**

Detailed instructions are included in the application kits.  All

applications must clearly indicate the relevance of the proposed work

to the stated purpose of this program announcement.


Applications will be reviewed for scientific and technical merit by

an Initial Review Group (IRG) composed primarily of non-Federal

scientific experts.  Final review is by an appropriate national

advisory council; review by Council may be based on policy

considerations as well as scientific merit.  By law, only

applications recommended by the Council may be considered for

funding.  Summaries of IRG recommendations are sent to applicants

following completion of the IRG review.

Review Criteria

General criteria used in the review of all applications include:

o  Significance and originality of the research from a scientific and

technical viewpoint

o  Adequacy of the theoretical and conceptual framework of the

proposed research and appropriateness of research methods

o  Demonstrated access to research subjects or data to conduct the


o  Demonstrated research capability, experience, and level of

commitment of the research staff

o  Adequacy of facilities, general environment, and core resources

for the development and implementation of the proposed research

o  Evidence of cooperation and commitment from persons and/or

organizations whose support is essential for the conduct of the

research; appropriateness of the collaborative arrangements

o  Adequacy of the plan to protect research subjects

o  Appropriateness of the proposed budget and duration in relation to

the proposed research

o  Conformance of the application to NIH policy on inclusion of women

and minorities in study populations

o  Potential contribution of the research study to the current

national health care reform initiatives

Applications will be reviewed in accordance with the regular review


NOTE:  Receipt dates for Investigator-Initiated Interactive Research

Project Grants (IRPG) are:  October 15, February 15, June 15.


Applications recommended by a National Advisory Council will be

considered for funding on the basis of overall scientific and

technical merit of the research as determined by peer review, program

needs and balance, and availability of funds.


Written and telephone inquiries are encouraged.  The opportunity to

clarify any issues or questions from potential applicants is welcome.

Inquiries regarding scientific and programmatic issues may be

directed to:

Agnes Rupp, Ph.D.

Division of Epidemiology and Services Research

National Institute of Mental Health

5600 Fishers Lane, Room 10C-06

Rockville, MD  20857

Telephone:  (301) 443-4233

FAX:  (301) 443-4045

Inquiries regarding fiscal matters may be directed to:

Diana S. Trunnell

Grants Management Branch

National Institute of Mental Health

5600 Fishers Lane, Room 7C-15

Rockville, MD  20857

Telephone:  (301) 443-3065

FAX:  (301) 443-6885


This program is described in the Catalog of Federal Domestic

Assistance No. 93.242.  Awards are made under authorization of the

Public Health Service Act, Title IV, Part A (Public Law 78-410, as

amended by Public Law 99-158, 42 USC 241 and 285) and administered

under PHS grants policies and Federal Regulations 42 CFR 52 and 45

CFR Part 74.  This program is not subject to the intergovernmental

review requirements of Executive Order 12372 or Health Systems Agency



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