There are 3 main medication-related issues for mental health care, which includes polypharmacy, nonadherence to prescribed medication, and underutilization of medications.
Approximately 27% of individuals with a diagnosed behavioral health condition accounted for 57% of the total annual health cost, according to Yoona Kim, PharmD, PhD, co-founder and CEO at Arine Inc.
During a session at the Academy of Managed Care Pharmacy Nexus 2023, she said that there are 3 main medication-related issues in chronic health conditions, particularly behavioral health, including polypharmacy, nonadherence to prescribed medication, and underutilization of medications. In the past few decades, there has been an increase in polypharmacy, with 60% of adults having behavioral health conditions with 2 or more psychotropic medications, according to Kim. She added that the consequences of polypharmacy include the risk of drug-drug interactions and adverse effects, causing an increase in emergency department (ED) visits and hospitalizations, thus impacting the overall health care cost.
“There are some keyways in which [polypharmacy] happens. The first that I see commonly is a medication that started and there's a personal response to the medication, and instead of maximizing that medication or stopping it, another one just gets added to it, and another, and another,”Caroline Carney, MD, president and chief medical officer at Magellan Health, said in the session.
Carney added that patients with similar conditions are often treated for the conditions separately. For example, if a patient has anxiety and depression, a single medication could treat both conditions; however, sometimes 2 different medications will be used. Individuals may also be getting medications from multiple prescribers. If they go to a primary care physician, a specialist, and the ED, they might be prescribed different medications. Carney also added that physicians will sometimes prescribe a variety of medications in a day, saying that this could be due to a lack of training on medication, which is where the pharmacist’s role is very important.
Approximately 48% of individuals with major psychiatric disorders in North America were not adherent to their medications, Kim said. Nonadherence can lead to treatment failure, rehospitalization, poor quality of life, increased comorbidities, and increased risk of suicide.
Furthermore, in 2017, 56.8 million adults aged 18 years and older had a behavioral health condition, but approximately 70% did not receive treatment in the past year. Kim said that 18.7 million individuals were diagnosed with substance use, and 17.2 million were untreated. Similar results were seen with serious mental illness, with 11.2 million individuals having a serious mental illness, of whom 3.7 million were untreated, and 35.4 million had another mental illness, of whom 22.9 million were untreated, according to Kim.
“I think that the vast majority of non-psychiatrist prescribers are really concerned about prescribing psychotropic medications. They give very little training in doing that,” Carney said in the session.
Carney added that this could be due to black box warnings and other warnings. Additionally, there is also the challenge of overprescribing. Carney said that sometimes individuals who do not have a psychiatric diagnosis are getting prescribed psychiatric medications. Likewise, there are also individuals who do have behavioral diagnosis but have not been getting any behavioral health therapy or medications.
Kim and Carney said that some of the reasons for low treatment rates could be attributed to stigma and misdiagnosis, which contributes to racial disparities. Approximately 79% of individuals in a survey from 2015 to 2019, according to the session, had both chronic pain and mental health conditions, yet 40% never received mental health treatment. She said this could be because individuals think that mental health comes secondary to their chronic conditions.
Furthermore, in a survey cited in the session, 1 in 5 individuals in a workplace were completely comfortable discussing their mental health. However, Carney added that she believes the stigma is changing due to the number of younger individuals who are more willing to discuss their mental health.
Kim Y, Carney C. Using Medication Intelligence to Improve Behavioral Health Outcomes. AMCP Nexus 2023. Orlando, Florida. October 18, 2023. Accessed October 18, 2023.