Across the United States, millions of people are affected by mental illness each year.
As clinicians in both the pharmacy and medical fields, we recognize we have a unique opportunity to work together to foster connections in behavioral health and share the responsibility of addressing the complex challenges within this space.
Before we dive into challenges and solutions, let's talk numbers. In the United States, 1 in 5 people experienced a mental illness in 2021, according to the National Alliance on Mental Illness (NAMI). That’s nearly 58 million people across the country. That same year, one person died by suicide in this country every 11 minutes. These numbers suggest that everyone either knows someone or has personal experience with these issues.
There is a false dichotomy that has been created when we discuss behavioral and physical health conditions. It is crucial that we acknowledge the mind body connection if we intend to make any meaningful impact. We created and labelled systems such as the brain/nervous system, heart, lungs, etc. to better understand and study them. But within us, our bodies don't know where the brain ends and heart begins – it is all interconnected. Meaning physical and mental health are intimately related to one another and impact each other greatly. Attention needs to be paid to both whenever we are attempting to heal.
Of adults with mental illness, 68% also have a diagnosed medical condition. Mental and medical illnesses have a reciprocal relationship and that is critical to acknowledge to be able to improve and enhance care. For example, those diagnosed with depression double their risk of developing diabetes, and those diagnosed with diabetes have double the risk of developing depression. In addition, those with depression have a 40% higher risk rate of developing cardiovascular and metabolic diseases than those in the general public, according to NAMI.
This reciprocal relationship is important to note because medical illnesses increase the risk for mental illness, and vice versa, leading to complications felt by the individual, their families, communities, and the broader global economy. Depression and anxiety disorders alone cost the global economy $1 trillion in lost productivity last year.
In healthcare, we are seeing evolving trends to support the connection of physical and behavioral health to improve health outcomes, support healthcare efficiency, and reduce barriers and costs. Trends include connecting physical and behavioral health in the primary care setting to support whole health care; creating telehealth and digital therapeutics; establishing prescription drug monitoring programs to increase medication adherence; growing specialty pharmacy initiatives; and increasing focus on personalized medicine.
But challenges and barriers still exist within the behavioral health space that include access to care, costs of medications, medication adherence, normalizing cultural and self-awareness stigmas, adoption of newly created digital tools, and constant regulatory challenges.
As a pharmacist at CarelonRx, and medical director at Carelon Behavioral Health, we find there are five factors we can implement together to positively influence the future of behavioral health care:
- Generate Awareness: Understanding the scope and impact of behavioral health conditions is critical to reducing the shame and isolation these conditions can bring. By generating conversations and normalizing experiences with these conditions we can engage in meaningful preventative and proactive mental health care.
- Provide Holistic and Integrated Care: Behavioral and physical health conditions often require a comprehensive, multidisciplinary approach for effective management. Integrating physical and mental healthcare is necessary for holistic treatment plans and improved healthcare efficiency.
- Lead with Empathy and Communication: Open, empathetic conversations about mental health can go a long way in creating supportive environments for affected individuals.
- Establish Prevention and Resilience: Early detection and intervention, preventive care, and building resilience are significant factors in managing behavioral health issues. This includes emphasizing healthful living including the importance of connecting socially, reducing intake of ultra processed foods, and staying physically active. Ensuring equitable access to quality behavioral health services for all individuals, regardless of age, socioeconomic status, or geographical location, is essential. In areas with a shortage of behavioral health professionals, pharmacists can serve as valuable, accessible healthcare resources, performing screenings or providing relevant health education. Consultation lines can also help address the shortage of psychiatrists and further emphasize whole person care by providing guidance on managing behavioral health conditions to primary care clinicians.
- Actively Manage Medications: Proper medication management, including considerations of drug interactions, side effects, and dosage compliance, plays a pivotal role in improving outcomes for individuals with behavioral health disorders. As key members to an integrated health team, pharmacists can monitor an individual’s response to medication, progress, and overall health between provider visits. They can then provide medication feedback to the provider, allowing for dynamic adjustments to treatment plans. They can also ensure that adequate testing for levels and lab monitoring for side effects has been completed when appropriate.
By forging collaborative partnerships, pharmacists and providers can deliver a more cohesive, effective, and patient-specific approach to managing behavioral health, potentially improving patient outcomes, and the quality of care. For those interested in learning more, we recently had the opportunity to further break down these five tips during a webinar called, "Beyond the Shadows: Fostering Connections in Behavioral Health."
Ultimately, behavioral health conditions are common and treatable. The more that can be done to increase understanding, reduce shame, and advance collaborative, integrated healthcare, the better the outcomes for individuals and families affected by these conditions.
Ami Bhatt, PharmD, is the Staff Vice President of Clinical Pharmacy Services at CarelonRx, Elevance Health's pharmacy benefit manager; and Dr. Simreet Khaira, MD, is the Manager Medical Director at Carelon Behavioral Health.