Furthermore, the research grant review process is fraught with difficulties across the institutes. These include lack of high-quality proposals, lack of proposals from minority investigators, lack of expertise in preventive intervention research on review committees that sometimes consider epidemiology, treatment, and prevention grants, vested interests on review committees that are dominated by “inside” prevention scientists (partly because prevention is still a small and young field), and reluctance of some review committees to allow investigators to combine funding streams from different institutes or agencies or to cross from one institute to another.

Even though other agencies, such as the Maternal and Child Health Bureau and the Administration on Children and Families within DHHS, as well as the Department of Defense, the Department of Education, and the Department of Justice, are valuable contributors and should be included in any coalition-building effort, none has enough current expertise on mental disorders to become the lead agency. The Office of Health Promotion and Disease Prevention has had an important role in coordinating information about prevention services and research within DHHS, but it too lacks expertise on mental disorders. Some of these agencies also lack expertise in research methodology.

The Centers for Disease Control and Prevention clearly has the best delineated mandate for prevention among federal agencies, and it has excellent outreach capabilities through public health departments. Recently, it has taken a more active role in prevention of violence and the prevention of problems associated with low birthweight. However, its current expertise in mental disorders is quite limited.

Conclusions

There is little coordination of prevention research or prevention services across federal agencies, or among federal agencies, universities, and private foundations. In addition, research institutes and agencies frequently ignore issues of co-morbidity of mental disorders and of mental and physical disorders, as well as the co-existence of mental disorders and social and legal problems, such as delinquency. A less categorical approach to interventions may be productive to individuals as well as society, but there is no clear lead agency to provide such an approach. No agency has both the expertise in mental disorder preventive intervention research and an established track record in working collaboratively with other agencies and departments on prevention. Therefore the committee concludes that an alternative mechanism is



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