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Exerpts from the National Institute of Mental Health research announcements:

STUDIES OF SUICIDE AND SUICIDAL BEHAVIOR
Program Announcement
National Institute of Mental Health, October 1988 (revised August 1995)

BACKGROUND Suicide is the ninth leading cause of death in the United States and the third leading cause of death among persons 15-24 years of age. Suicide rates for all age groups combined have not substantially decreased since the 1950s. The youth suicide rate has tripled. The highest rate for any age group are 70.3 per 100,000 among white males 85 years of age and older. Certain specific risk factors have emerged which increase an individual's risk for suicide and which can serve as a basis for further studies and carefully planned prevention efforts. For example, there is strong clinical and epidemiologic evidence that psychiatric or substance abuse disorders, or their comorbid occurrence, are powerful, independent risk factors for suicidal behavior. Other independent risk factors include availability of firearms, gender, age, disrupted familial environment, and incarceration. Family history findings suggest the possible existence of biological risk factors for suicide. The Secretary's Task Force on Youth Suicide made strong recommendations for further research on this complex problem. Reduction of suicide and suicidal behaviors has been targeted in two priority areas in "Healthy People 2000: "Mental Health and Mental Disorders, and Violent and Abusive Behavior. Special emphasis has been placed on the population groups at high risk--young people, the elderly, and American Indians and Alaska Natives.

RESEARCH ON THE MENTAL HEALTH OF MINORITY POPULATIONS

PURPOSE: The National Institute of Mental Health (NIMH) announces support for the development, conduct, and maintenance of research program projects (RPPs) (P01) focusing on the mental health of minority populations.

All research areas supported by NIMH are relevant to the mental health of minority populations and are appropriate as the central focus for program project research.
    The specific minority populations NIMH will award grants to study include: American Indians/Alaskan Natives, Asian Americans, African Americans, Hispanics, and Native Hawaiians/Pacific Islanders. Studies of ethnic subpopulations within these broad categories are also encouraged.

This program announcement supersedes PA-92-122, Minority Mental Health Research Centers, issued September 1992.

RESEARCH OBJECTIVES: The principal objective of this program is to provide a research environment in which state-of-the-art research methodologies may be applied to an interdependent set of projects relating to a single major focus in mental health research. The research focus may include the understanding and improvement of mental health and the prevention and treatment of mental illness among the specific minority group(s) selected under this announcement.

RESEARCH ON QUALITY OF CARE FOR MENTAL DISORDERS

PA NUMBER: PA-95-066

PURPOSE: The purpose of this program announcement is to encourage grant applications for research on the quality of care delivered in various settings for mental disorders. The goal is to further understanding of what contributes to quality of care and ultimately to ensure that people with mental disorders are provided the best care possible.  

Background: Quality of care research attempts to determine reasons for differences between clinically or scientifically derived standards of care and the actual care provided in everyday practice. In addition, it is concerned with how well the performance of providers increases the probability of desired patient outcomes. Studies of quality of care often separate the context of care into three components: structure, process, and outcome. Structure refers to characteristics of the community, service system, and client that might affect process and outcome (e.g., system configuration, demographics, staffing ratios, ownership). Process refers to interventions that are intended to influence the course of a disorder (e.g., assessment, treatment approaches). Outcome refers to the impact of interventions on the disorders and client (e.g., clinical status, quality of life, expenditures, satisfaction).
    The quality of care provided to people with mental disorders varies across the Nation and among different service sectors. Recent changes in the organization and management of mental health services have heightened concern that quality of care may become compromised. Delineation of the components of good care and improved understanding of the factors that contribute to variation in the quality of care can help to ensure that the best treatment is provided.

RESEARCH ON EFFECTIVENESS OF CHILDREN'S MENTAL HEALTH SERVICES

PA NUMBER: PA-94-094

PURPOSE: This program announcement, based on recommendations set forth in the National Plan for Research on Child and Adolescent Mental Disorders, is intended to encourage investigator-initiated research grant applications for studies of the effectiveness of mental health services that are being provided to children, adolescents, and their families through the Center for Mental Health Services (CMHS) Comprehensive Community Mental Health Services Program initiative.

Background: Recent reviews of prevalence studies indicate that approximately 14 to 20 percent of children and adolescents in the United States have a diagnosable mental, emotional, or behavioral disorder. Because children with serious emotional disturbances frequently manifest problems in many domains, including home, school, and community, they require the intervention of other agencies and systems to provide special education, child welfare, health, substance abuse, vocational, and, often, juvenile justice services. Service-providing agencies often have requirements and eligibility rules that make it difficult for families whose children have mental health needs to obtain requisite services. Consequently, in the past decade, a growing interest has emerged favoring the provision of a comprehensive array of mental health and other services to meet the needs of these youth and their families.
    In response to this interest, the Comprehensive Community Mental Health Services Program for Children with Serious Emotional Disturbances was created (as part of the ADAMHA Reorganization Act--P.L. 102-321, Sec.119). This program is administered by the Center for Mental Health Services (CMHS) of the Substance Abuse and Mental Health Services Administration (SAMHSA). Under this authority, grants are provided to States, political subdivisions of States, Indian tribes, or tribal organizations to provide a broad array of comprehensive community-based services for children with serious emotional, behavioral, or mental disorders in order to enable communities to develop local systems of care consisting of mental health, child welfare, education, juvenile justice, and other appropriate agencies.
    Funds for the CMHS program are authorized to be spent on services that are underdeveloped or nonexistent in most communities: respite care; day treatment; therapeutic foster care; intensive home-based services; school or clinic-based services; emergency services; and diagnostic and evaluation services. Additionally, each child must have an individualized service plan, developed with the participation of family and, where appropriate, the child. The plan must designate a case manager to assist the child and family by coordinating services among several systems.
    To date, 11 sites have been awarded five-year grants by CMHS under the Request for Applications that was announced in the Spring 1993. Up to 10 additional sites may be awarded by September 30, 1994, under a new CMHS Request for Applications. An evaluation plan that will encompass all of the sites is being developed by CMHS.
    Through this program announcement, NIMH invites applications for studies of the effectiveness, including cost-effectiveness, of these comprehensive service models.

AMERICAN INDIAN, ALASKA NATIVE, AND NATIVE HAWAIIAN MENTAL HEALTH RESEARCH

PA NUMBER: PA-93-53

PURPOSE: The purpose of this announcement is to encourage research and research demonstration applications for studies among American Indian, Alaska Native, and Native Hawaiian populations of the epidemiology and prevention of mental disorders, co-occurring substance abuse disorders, and suicide; family and individual coping styles and resiliency; family violence; and mental health service use and quality of care. It is the goal of this initiative to improve the care and quality of life of American Indians, Alaska Natives, and Native Hawaiians who suffer from mental illnesses.

RESEARCH OBJECTIVES: Much about the mental health needs of American Indians, Alaska Natives, and Native Hawaiians is unknown. Little is known about the epidemiology and prevention of adult or child mental disorders; co-occurring substance abuse disorders; family violence and family dysfunction; cultural, economic, or geographic barriers to care; appropriateness and effectiveness of treatment; need for services; and service use patterns. To begin to address these issues, NIMH, in conjunction with the National Institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse, issued a program announcement in March 1990, "Epidemiologic and Services Research on Mental Disorders that Co-occur with Drug and/or Alcohol Disorders Among American Indians, Alaska Natives, and Native Hawaiians." The purpose of that announcement was to encourage investigators to test further the reliability and validity of current psychiatric and service system measures for native populations and to begin to estimate the prevalence of disorders and service use.
    This announcement is intended to stimulate a broader range of mental health research related to American Indians, Alaska Natives, and Native Hawaiians. By addressing issues relating to epidemiology, prevention, family and individual coping styles and resiliency, family violence, and service use, treatment, and quality of care, progress can be made toward improving the quality of life of American Indians, Alaska Natives, and Native Hawaiians whose lives are affected by mental illness, co-occurring substance abuse disorders, and often-related family dysfunction.