Treatment adherence: Factors, challenges, and solutions

Paul R. Swaim; MEd, ALC

MENTAL ILLNESS: CLOSING THE GAP BETWEEN NEEDS AND SERVICES

-THE DISCONNECT BETWEEN PATIENT AND PROVIDER EXPECTATION

Why this information is important

The burden and financial strain of mental health problems

The stigmatization of mental illness

Individual and provider understanding of mental illness

How to close the gap

Overview and Objectives

CLOSING THE GAP

One in 4 people develop one of more mental disorders at some stage in their life. 10

450 million people per year 10

Mental Health problems represent 5 out of 10 of the leading causes of disability worldwide nearly 1/3 of disability in the world. 10

US Surgeon General: Mental Illness is the second cause of disability affects 20% of Americans. 2

WHY THIS INFORMATION IS IMPORTANT

Poor are disproportionally affected burden placed on

them and their families

social stigma lack of resources lack of knowledge

and understanding 10

Approximately 297 disorders in DSM V

Depression, Substance Use Disorders, Schizophrenia, Bipolar Disorder

Only half receive services 10

80% - some form of treatment 8

10 years 8

WHY THIS INFORMATION IS IMPORTANT-THE GAP

With treatment

Symptoms are controlled in about 70% leading to a decrease

in recurrence 8

Without treatment

½ million with Severe Mental Illness (SMI) fall through the cracks 7

die, on average, 23 years sooner than other Americans 7

TREATMENT

As the population lives longer, there is an increase in the number of persons who develop a mental illness, which increases the burden on them and the rest of society,

WHY THIS INFORMATION IS IMPORTANT

Burden

Decrease in productivity at home and work. 10

lost wages catastrophic health care costs worsening poverty

THE BURDEN AND FINANCIAL STRAIN OF MENTAL HEALTH

PROBLEMS

US cost in 2001 averaged $148 Billion per year 2.5% of the gross

national product 10

5 times the amount ($30B) given as international aid- 2013 6

Adjusted percentage of 2013 cost was 11 times greater 6

2014- $444 Billion per year 7

Depression- $31 Billion dollars per year (CDC)

Bipolar disorder cost per case ranges

from $11,720 per manic episode

to $624,785 nonresponsive or

chronic episodes 5

FINANCIAL STRAIN

acute conditions vs. chronic disorders Nonadherence rates in patients with

schizophrenia, bipolar disorder, and depression are often greater than 50%

½ of MDD – 3 months after prescribed 32% to 42% - 6 to 8 weeks 34% of patients taking SSRIs and 20% taking

TCAs fi lled four or more prescriptions within 6 months

41% to 43% among patients with bipolar disorders 4

BURDEN- MEDICATION AND SIDE EFFECTS

Lack of insight

Attitudes towards medication

Attitudes towards condition

Relationships

Cognitive deficits

Physical conditions

REASONS FOR NONADHERENCE

Housing, employment, and other normal societal roles are often compromised exacerbates the symptoms 10

Inaccurate information about mental health Violent Bewitched Untreatable 10

Stereotypes Dangerous Unpredictable Responsible for their illness Generally incompetent 3

Leads to discrimination in employment, social, and educational opportunities 3

THE STIGMATIZATION OF MENTAL ILLNESS

40% mental health patients are arrested at some point in their lives minor violations such as loitering or public disturbance 7

15% of state prisoners and 24% of jail inmates are psychotic

350 K persons. 10 times more people than are being treated in hospitals 7

590K patients are treated in community mental health centers, jail, homeless, or are dead 7

QUANTIFIABLE INFORMATION AND STATISTICS REGARDING

STIGMATIZATION

Less than 1/3 of people seeking help receive minimal adequate care 8

States have been reducing hospital beds for decades insurance pressures desire to provide more care in outside institutions 7

States cut $5 Billion in mental health services between 2009 and 2012 7

Eliminated at least 4500 public beds (10%) 7

65% of beds for mental health patients are in separate hospitals 10

INDIVIDUAL AND PROVIDER UNDERSTANDING OF MENTAL

ILLNESS

5.5 Million admitted to the ER per year (4% of visits) 7

Many uninsured, hospitals uncompensated 7

Providers are less likely to: focus on the patient rather than the disease endorse recovery as an outcome of care refer to consult and follow-up care 3

AS A RESULT

Jail diversion programs of $400 K saves 1.3 M in emergency medical services and jail cost 7

Increase awareness and responsiveness to mental health issues

Increase quality and eff ectiveness of services Decrease stigma and disconnect Changes in DSMhttp://www.dsm5.org/Documents/changes%20from

%20dsm-iv-tr%20to%20dsm-5.pdf

60% depression, 60% decrease in substance use, 77% schizophrenia without relapse 8

HOW TO CLOSE THE GAP

1. Amer ican Psych iat r i c Pub l i sh ing (February 2014) . H igh l ights o f Changes f rom DSM- IV-TR to DSM- . Ret r ieved ht tp : / /www.dsm5.org/Documents /changes

%20from%20dsm- iv- t r%20to%20dsm- 5 .pdf. 2. The Car te r Center , ( Ju ly 30 , 2013) . The Car te r Center Menta l Hea l th Program: Combat ing

the s t igma of menta l i l l ness . Ret r ieved www.car te rcenter.org /news/pr /arch ive -2013 .html

3. Corr igan, PW; Druss , BG; Per l i ck , DA (2014) . The impact o f menta l i l l ness s t igma on seek ing and par t i c ipat ing in hea l th care . Psycho log ica l Sc iences in the Pub l i c In te res t . 15 (2 ) , 37 -70 .

4. Lee , KC ( June 2013) . Improv ing medicat ion adherence in pat ients w i th severe menta l i l l ness . Amer ican Pharmac is ts Assoc iat ion . Pharmacy Today. 2013( Jun) ;19(6 ) :69–80

5. NAMI (2015) The impact and cost o f menta l i l l ness : The case o f b ipo lar d i s roder. Ret r ieved ht tp : / /www2.nami .org /Template .c fm?Sect ion=bipo lar_d i sorder&template=/ContentManagem ent /ContentD isp lay.c fm&Content ID=42734

6. Sauter , MB; We ig ley , S ; Hess , AEM (Apr i l 11 , 2013) . The most generous count r ies in the wor ld . The Wal l S t ree t Journa l .

7. Szabo, L . (2015) . Cost o f not car ing: Nowhere to go . The fi nanc ia l and human to l l fo r neg lec t ing the menta l l y i l l . USA Today.

8. Wang, PS ; Berg lund, P ; O l fson , M; Pincus , HA; We l l s , KB; Kess le r , RC ( June 2005) . Fa i lure and de lay in in i t i a l t reatment contac t a f te r fi rs t onset o f menta l d i sorders in the nat iona l comorb id i ty survey rep l i cat ion . Ach ieves o f Genera l Psych iat ry. 62 (6 ) , 603-613 .

9. We iss , R ( June 7 , 2005) . Study: US leads in menta l i l l ness , l ags in t reatment . The Wash ington Post . Ret r ieved ht tp : / /www.wash ingtonpost .com/wp-dyn/content /ar t i c le /2005 /06 /06 /AR2005060601651 .html .

10. Wor ld Hea l th Organ izat ion (2012) . Close the gap, dare to care . Menta l hea l th g loba l ac t ion program. Ret r ieved ht tp : / /www.who. int /menta l _hea l th /media /en/265 .pdf.

WORKS CITED