None

National Institute of Mental Health (NIMH)

The National Institute of Mental Health intends to publish a Funding Opportunity Announcement (FOA) to solicit applications to develop, optimize, and test innovative theory-based strategies to integrate mental and physical health care within health care systems in low- and middle-income countries (LMICs). 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 Winter 2021 with an expected application due date in Spring 2022. This FOA will utilize the R01 activity code. Clinical trials will be optional. Details of the planned FOA are provided below.

Globally, more than 75 percent of people do not receive treatment for mental, neurological, and substance use disorders. Mental illnesses occur more commonly in people with other physical and chronic health conditions such as cardiovascular disease, diabetes, alcohol and substance use disorders, HIV/AIDS, and more recently, people infected with COVID-19. Mental illnesses occur more commonly in people with other physical and chronic health conditions.

Individuals with comorbid conditions typically present lower treatment adherence, poorer clinical outcomes, and a higher risk of disability and mortality. Integrating mental health care into health care systems is a promising strategy to help expand access to mental health care and treat coexisting conditions.

Research Scope and Objectives

The NIMH Center for Global Mental Health Research intends to issue a Funding Opportunity Announcement (FOA) to support implementation research to develop, optimize, and test innovative strategies to integrate mental and physical health care within health care systems in low-and middle-income countries (LMICs). This initiative aims to support innovative research for implementing, scaling up, and sustaining accessible and effective integrated mental health care models to ultimately increase demand and utilization, quality, access, and availability of mental health care. This initiative is also expected to contribute to the long-term goals of strengthening the sustainable research capacity in LMICs and enhancing the potential for multidirectional knowledge and the exchange of research advancements.

Researchers are expected to describe how the proposed research is relevant to the local context and aligns with NIMH's scientific priorities of transforming the prevention and treatment of mental illnesses and translating evidence into practice and policy.

Applications may propose new studies or secondary data analyses. All projects must describe the extent of researchers' significant involvement in LMICs settings and propose a research component and research capacity component. All applicants will be expected to substantially involve key personnel in the setting where the study will be executed.

Applications to conduct secondary analyses are expected to demonstrate the sufficiency of existing data sets in quantity and quality to test hypothesized mediational pathways or generate new hypotheses using computational and data science analytic approaches.

Applicants proposing original data collection are expected to propose an integration of mental health services into existing health care systems or other existing platforms of care for physical conditions such as primary care settings, community care centers, platforms for chronic disease management, and those used to support mobile populations. Applications are also expected to assess and evaluate more than one mental illness AND one or more physical health outcomes. Economic evaluation and budgetary impact analyses are also expected. Applications are also expected to generate new information concerning the structure of the health system and test strategies to overcome barriers in the supply of these services and potential policy interventions to facilitate its scaling up and sustainability. Of specific interest is research that uses task-sharing, innovative digital health technologies, and syndemic frameworks, where appropriate. The use of competency-based training approaches and competency assessments is strongly encouraged, in order to improve quality of care and reach (accurate detection).

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

• Identify and implement an optimal integration model to ensure scalability and sustainability
• Identify the necessary core elements of integrated mental health care models (e.g., routine screening, training/hiring case manager and consulting, disease registry)to enable the model’s implementation, scale-up, and sustainability.
• Develop and test implementation strategies and innovative health technologies to improve health system-, patient-, and family-level outcomes and ensure the quality of integration.
• Develop and test models and strategies for training, supervision, and supporting providers, including identifying the optimal functions, roles, and composition of integrated care teams to deliver integrated care with fidelity and high quality.
• Test mechanisms of actions/ target mediators of implementation strategies for overcoming barriers to the adoption, adaptation, integration, scale-up, and sustainability of integrated care models
• Develop and test models and strategies for linking integrated care with other community-based services.
• Develop and test behavioral economic strategies, financing models (payment mechanisms), and health policies that influence the success of scaling up and sustaining the provision of integrated care; by including them on the universal health system and a cost-effective bundle of service.
• Determine how an integrated care model can best engage local communities to enhance service user participation (e.g., demand and utilization).
• Examine the independent and complementary or synergistic effects on the mental and physical health outcome of an integrated care model with multilevel interventions targeting modifiable conditions (e.g., the structure of the health system, health policies, and other social drivers of mental illness)
• Test strategies that target health system arrangements, such as incentives, regulations, and policies, which may facilitate or deter the availability (supply), accessibility, scalability, and sustainability of integrated care model and test relevant approaches to measure and extract existing data regarding these arrangements.

Eligibility

For applications proposing a single PD/PI, the PD/PI will be required to have 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. For applications proposing a single PD/PI, the PD/PI will be required to have 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