For many years, these foundations and many others have provided substantial research and service funds for prevention, including the reduction of various risk factors associated with the onset of mental disorders. The network for information sharing and joint funding of projects among federal agencies and private foundations is an informal one, relying heavily on the individuals involved, much as it is within the federal agencies.

The extent to which the private and public funding sources overlap to provide for the career development of prevention researchers and for joint sponsorship of research projects could not be determined because there is no mechanism for recording this type of information. However, it appears that the overlap, at least sequentially, for a particular project or researcher may be considerable.

To coordinate these diverse participants in prevention, a lead agency would require several attributes. The ability of the lead agency to bring together all the interested federal, state, and private parties to facilitate an open sharing of ideas and information, a commitment to the investigations of multiple, co-existing risk conditions for mental disorders and the co-morbidity of dysfunctions and disorders, and a willingness to participate in joint projects are all essential. A commitment to prevention, as distinguished from treatment and maintenance, is equally important in the lead agency.

To place such a leading role outside the federal government does not seem possible, because the bulk of funds for preventive intervention research and service will continue to come from the federal government.

The reorganization of ADAMHA complicates the picture. With the split between research and services, none of the remaining agencies covers all the bases. SAMHSA has a clear role in the delivery of preventive services regarding drug abuse, but its role in prevention of other mental disorders is less clear. Although prevention is part of the mandate to SAMHSA's Center on Mental Health Services, there is no mandate establishing an Office of Prevention, and no support for prevention coordination was authorized. Each of the three research institutes at NIH (NIMH, NIDA, and NIAAA) has an Office of Prevention. The new law does not, however, establish any overarching authority to coordinate their activities, and categorical funding has contributed to competitiveness and isolation of the institutes from each other. It remains to be seen how these three research institutes will dovetail with the already established Health and Behavior Committee and Prevention Coordinating Committee at NIH. The links between the research institutes and the service programs at ADAMHA were already tenuous; coordination may now be even more difficult.



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