Notice of Interest to Highlight High-Priority Time-Sensitive Research Opportunities Toward Zero Suicide Healthcare Systems

Notice Number: NOT-MH-17-031

Key Dates
Release Date: June 14, 2017

Related Announcements
None

Issued by
National Institute of Mental Health (NIMH)

Purpose

NIMH is issuing this Notice to highlight its interest in receiving grant applications focused on applied research that advances the National Action Alliance for Suicide Prevention's “Zero Suicide” goal of preventing suicide events (attempts, deaths) among individuals receiving treatment within health care systems. Zero Suicide is a commitment to the prevention of suicide among individuals served by health care systems and is also a specific set of health care strategies and tools intended to eliminate suicide events.  This Notice specifically encourages applications that leverage time-sensitive opportunities and clinical infrastructure, including collaborations with organizations supported through the Substance Abuse and Mental Health Services Administration’s (SAMHSA) recently announced cooperative agreement initiative to implement Zero Suicide in health systems (https://www.samhsa.gov/grants/grant-announcements/sm-17-006).

Research is needed to implement effective and comprehensive suicide prevention strategies in a variety of settings, including behavioral health and substance abuse outpatient clinics, emergency departments and crisis care programs and centers, hospitals, and integrated primary care programs.  Research is needed to improve health care approaches for the following: systematic approaches to suicide risk detection (acute or long term); appropriate risk documentation and follow-up care that is practical and effective; interventions earlier in the course of suicide risk trajectories that reduce incident suicide events in care systems; identification of effective service delivery components that work as safety nets to prevent suicidal events; and identification of service delivery policies and practices that support and maintain “Zero Suicide” goals and reduce suicide events.

This Notice encourages applications that leverage existing health care networks with adequate infrastructure (e.g., electronic health records; networked health care systems) and services research expertise in quality improvement strategies, in order to improve the efficiency and relevance of research on suicide reduction approaches.  The learning healthcare system envisioned by the Institute of Medicine would be an ideal platform for these ‘Zero Suicide’ efforts that improve patient care, and also allow for the process of scientific discovery.  Analytic approaches used within learning health systems can include randomized controlled trials, quasi-experimental designs with non-randomized comparison groups, time series designs, and other designs of equivalent rigor and relevance.  

Applicants are encouraged to review the Prioritized Research Agenda for Suicide Prevention regarding the state of the science, research priorities, and potential research pathway (in particular, Key Questions 2, 3 and 4). Researchers are also encouraged to consider state collaborations in order to utilize morbidity and mortality surveillance systems (many supported by CDC, http://www.cdc.gov/injury/wisqars/  and http://www.cdc.gov/injury/wisqars/nvdrs.html). ¬†States implementing laws regarding provider training in suicide mitigation may offer opportunities to study implementation of improved provider skills and its benefits for suicide reduction in care systems.  Leveraging federal investments that support behavioral health needs (SAMHSA funded services within states:  http://www.samhsa.gov/grants-awards-by-state), and primary care (HRSA funded services within states:  http://datawarehouse.hrsa.gov/Topics/HrsaInYour.aspx) are also important opportunities, as a number of these investments include suicide prevention as bench mark outcomes.

Examples of studies that are encouraged through this Notice include, but are not limited to those that: 

  • develop and test strategies to promote engagement and continuity of care during known periods of heightened risk, such as care transfers between systems (e.g., handoffs between emergency departments and inpatient psychiatric or substance abuse treatment; transitions between outpatient mental health/substance abuse programs and primary care settings)
  • develop and test clinical decision support tools that can be used to facilitate matching individuals to the appropriate intervention (e.g., in terms of type, intensity, and duration) depending on level of risk
  • test common but not proven suicide mitigation interventions (e.g., inpatient care practices; peer supported respite care) 
  • through practical trials, test the benefit of providing evidence-based care for reducing suicide risk, such as related risk screening (e.g., alcohol screening) safety planning, as well as implementation of psychosocial interventions known to reduce re-attempts (e.g., Caring letters, Cognitive Behavior Therapy; Dialectical Behavior Therapy, Problem Solving Therapy)
  • test mobile technology enhancements intended to improve health care system interventions (e.g., cell phone apps and/ or other telephonic monitoring and therapy)
  • determine the cumulative benefit of implementing multiple components of service delivery considered beneficial in suicide prevention (e.g., continuity of care; community collaboration for safe storage of lethal means; coordination with community crisis response; community outreach)
  • propose and test potential solutions for policy and implementation barriers (e.g., EMR tracking of attempts, reimbursement, approaches to involuntary commitment, incentives within and outside delivery systems to reduce suicide, system and provider liability, training and staffing needs)
  • as a component of quality improvement, test specific strategies for training providers to initial competency and for encouraging sustained fidelity in the use of research supported assessment and interventions.

All requirements of the relevant Funding Opportunity Announcement would need to be followed in any application (and award) that proposes to develop and conduct a study on one of these high priority areas.  Possible funding opportunities that can be used to pursue these and other research activities include, but are not limited to:

  • PAR-15-323, Pilot Services Research Grants Not Involving Interventions (R34)
  • PAR-17-264, Innovative Mental Health Services Research Not Involving Clinical Trials (R01)
  • RFA-MH-17-612, Pilot Effectiveness Studies and Services Research Grants (R34
  • RFA-MH-17-608, Clinical Trials to Test the Effectiveness of Treatment, Preventive, and Services Interventions (R01)
  • RFA-MH-17-610, Clinical Trials to Test the Effectiveness of Treatment, Preventive, and Services Interventions (Collaborative R01)
  • PAR-16-185, Products to Support Applied Research Towards Zero Suicide Healthcare Systems (R43/R44).
  • PAR-16-237, Dissemination and Implementation Research in Health (R03)
  • PAR-16-236, Dissemination and Implementation Research in Health (R21)
  • PAR-16-238, Dissemination and Implementation Research in Health (R01)
  • PA-16-160, NIH Research Project Grant (Parent R01)
  • PA-16-161, NIH Exploratory/Developmental Research Grant Program (Parent R21)
  • PA-16-162, NIH Small Research Grant Program (Parent R03)

Please note that investigators interested in pursuing clinical trial research should review the NIMH Clinical Trials Funding Opportunity Announcements ¬†website:  http://www.nimh.nih.gov/funding/opportunities-announcements/clinical-trials-foas/index.shtml and NOT-MH-14-007 which announced that beginning with applications submitted for the June 5, 2014 submission date and all subsequent applicable deadlines, NIMH will not accept R01, R21, or R03  applications that include clinical trials of potential therapies for mental disorders, under the NIH parent R01 Funding Opportunity Announcement (FOA) PA-13-302, NIH parent R21 FOA PA-13-303, and NIH Parent R03 FOA PA-13-304, and subsequent reissuances of these FOAs.  Specific guidance on application submission procedures are described in the notice.

Applicants considering such an application are strongly encouraged to consult with NIMH Program Officials prior to submission.

Inquiries

Please direct all inquiries to:

Adam Haim, Ph.D.
National Institute of Mental Health (NIMH)
Telephone: 301-435-3593
Email: haima@mail.nih.gov