The critically important yet often misunderstood field of behavioral health was the focus of a recent webinar in the CarelonRx Connects series. This article includes excerpted information from the presentation by Dr. Ami Bhatt, Staff VP Pharmacy Clinical Quality at CarelonRx, and Dr. Simreet Khaira, Manager Medical Director at Carelon Behavioral Health. Also included is perspective from James Polo, MD, Chief Medical Officer, Carelon Behavioral Health, on treating severe mental illness with medications.
Understanding serious mental illness
Serious Mental Illness (SMI) involves a wide spectrum of complex mental health disorders, typically characterized by intense durations and severe, life-disrupting symptoms. Commonly, SMI refers to a diagnosis of psyschotic disorders, but can also include treatment-resistant depression, anxiety disorders, eating disorders, and personality disorders, if the degree of functional impairment is severe.
It’s important for plan sponsors to understand that members with SMIs are suffering long-term illnesses that often require multiple treatment approaches and care providers over time. These conditions typically require active, ongoing management to treat symptoms, maintain stability, and prevent relapses. The prevalence of SMI* may come as a surprise:
- In any given year, approximately 4.5% of U.S. adults suffer from a serious mental illness.
- 14.1 million people had serious mental illness in 2021 alone
The impact of serious mental illness
SMIs can significantly disrupt an individual's ability to function in various life domains, including work, social connections, and self-care. Well-known SMIs include schizophrenia and bipolar disorder. Symptoms may include substantial impairments that often lead to an inability to maintain gainful employment, repeated psychiatric hospitalizations, and more. Implications often extend to physical health also, as individuals with SMI tend to have higher prevalence rates for various physical illnesses.
Treatment approaches
Treatment for SMIs typically incorporates a combination of focused psychotherapy and medication management, plus social and occupational support plays a role, as well. Active cooperation between patients, caregivers, and a diverse team of healthcare professionals is integral for effective SMI management. Antipsychotic medications are a mainstay treatment for conditions like schizophrenia, while mood stabilizers and antipsychotics are often used for bipolar disorder.
“The use of psychotropic medications to treat behavioral health conditions is very complex,” says James Polo, MD, Chief Medical Officer, Carelon Behavioral Health.
Dr. Polo goes on to explain, “While medications play an important role in the treatment of psychiatric illnesses, they do not change the way an individual thinks or the circumstances of their life… However, when medications improve the symptoms, the individual is more cognitively able to work on their illness. An individual can participate in more intensive psychotherapy, reframe their circumstances, and develop better coping skills to move forward with life.”
Connected pharmacy care
Some psychiatric symptoms are only treatable with medications. The medications commonly used for serious mental illness may cause side effects that can affect things such as metabolic and thyroid functioning. Some require periodic testing for levels as some drugs can be toxic if present at too high a concentration. This is where our pharmacy, care management, and provider quality teams can have a major impact helping providers and members.
For example, monitoring member data to identify and support pharmacy care needs may lead to providing outreach to ensure testing is completed at the recommended cadence. These activities also have cost savings implications, by helping to avoid development of conditions that can be more difficult to manage if they are not addressed early on.
Connected, member-focused pharmacy care can help enhance quality of care outcomes that plans must measure and report, and the health outcomes that employees with serious mental illness deserve.
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