The stigma of mental health disorders is slowly disappearing, and that’s a very good thing. You see evidence of this everywhere: on TV and social media, in ad reads on podcasts, even in the traditionally don’t-show-weakness world of professional sports. There is growing acceptance of discussions around mental health.
Unfortunately, despite this cultural change, the prevalence of mental health disorders appears to be increasing, and well-known examples of its unfortunate consequences are all too common.
Medication is a huge part of maintaining mental health for millions of Americans, but clearly the pharmaceutical industry is facing challenges in addressing this problem. I see three main obstacles to progress: adherence, cost and innovation.
Adherence interference
Non-adherence to medication is an age-old and familiar problem, but it has an outsized impact in the mental health realm, where there are more complex barriers to prevent patients from following their healthcare providers’ recommendations. Adherence is difficult to measure accurately, but it’s estimated that more than half of patients with mental health problems struggle with taking their meds as directed.
There are multiple reasons for non-adherence: Patients may simply forget to take their medication at the right time, or they may be confused or in a state of mind that makes it difficult to comply with a drug regimen. They might have misunderstood a provider’s instructions and believe they’re taking the medication correctly when they’re not. They might stop taking medication because of its side effects, or they might feel better and decide they no longer need it. They might worry about dependency. There can also be physical difficulties taking medication, especially with injectables. And patient self-reporting can be inaccurate when it comes to gauging adherence.
Prepacked prescription services, which sort pills into daily packets so patients don’t have to fuss with bottles, is one of the many ways to improve adherence. Technology is another: Digital monitoring uses tools such as smart packaging (wired pill-bottle caps or blister packs) that can track whether and when a patient takes a medication. Smart packaging is usually linked to an integrated app to help both patients and providers keep track of prescribed medications. In addition, there are edible digital sensors that can be embedded in some types of medicine; the sensor is activated by gastric acid when swallowed, which sends a notification to the provider via smartphone. (The FDA approved the first drugs using this technology for treating mental health disorders in 2017.)
Smart pill bottles and the like aren’t a new concept—they’ve been on the market for decades. Similar forms of adherence-monitoring technology have been used to improve the effectiveness of clinical trials (because lower adherence means a smaller usable sample size and an underpowered trial). But the adoption of digital tools in the treatment of mental health issues generally has been slow. We need to devote more resources to studies that determine which tools and which approaches actually work best to improve adherence.
Cost creativity
Digital tools are also an incomplete solution. For one thing, patients can easily remove a pill from a smart bottle but not take it. Most digital tools also require the use of a cellphone, which not everyone has access to. Cost is also a major issue: Patients can’t take their meds if they can’t afford them. A recent poll showed that 1 in 10 adults reported not taking their medications as prescribed because of cost.
Mental health laws require access, but that does not mean the drugs are affordable. The cost of mental health generics varies wildly depending on the formulary used by a given health plan. One way to drive down costs is custom formularies for health plans catering to populations particularly in need of mental health medications. I was involved in creating the first student-focused formulary, and it’s a model I hope others adopt.
An opportunity for innovation
Despite the huge number of Americans affected by mental health disorders, innovation in this area of healthcare has been comparatively sluggish. Mental health disorders affect a larger population than cancer, yet there’s a higher financial incentive for innovation in oncology than in mental health. That needs to change. Research and development are key to both improving adherence and to lowering the costs of treatment. For example, major depressive disorder has been around forever, but it’s only been in the past couple of years that research has unveiled new and innovative treatments such as cannabis-based drugs or psychedelic treatments for mental health.
HIV is a success story for the pharmaceutical industry. This virus is now manageable with medication, completely changing the outlook for people who are HIV-positive. With increasing focus on mental health around the world and little innovation in recent years, my hope is that a variety of mental health disorders will be the next success story for our industry.
Ralph Pisano is president of RemedyOne.