Access to Treatment Is a Severe Barrier for Patients With Mental Illness: Michael McGuire, PharmD

Michael McGuire, PharmD, reviewed Mental Health America’s recent publication on the current state of mental health in America and addressed socioeconomic barriers in access to care, particularly for patients with serious mental illnesses. The publication seeks to raise awareness and inform stakeholders of the persistent mental health disparities affecting communities across the country.

The report highlights multiple instances in which unstable housing significantly disrupts patients’ access to and adherence with mental health medications. In response, McGuire, whose practice is based at Belmont University, has implemented strategies such as providing patients with multi-month supplies of medication at discharge and considering once-monthly injectable treatments to support continuity of care.

The report also noted that patients in rural counties experience worse mental health outcomes compared with those in metropolitan areas. McGuire attributes this disparity to the uneven distribution of mental health care providers nationwide, which continues to limit access in underserved regions.

Transcript

The report found that over 76% of adults with substance use disorder did not receive treatment. In your experience, what are the biggest barriers keeping individuals with serious mental illness from initiating or continuing care?

At play there, just access to care is one of the biggest things—people not knowing where to go to access services, you know. If you're talking about substance use disorders, sometimes substance use disorder treatment is separate from mental health treatment, and so you may go one place for substance use treatment and go somewhere else for mental health treatment. A lot of places don't integrate those two, so finding the right place to go can sometimes be a challenge for people. And I've encountered this fairly often where you have patients with mental illness that need to go to substance use treatment, and those substance use facilities preclude them from taking mental health meds. And some of them are meds that are really essential, and they can't take the mental health meds. So that excludes some facilities from being an option for some patients.

One of the biggest things I think we continue to face is stigma. Stigma about seeking care, fears of, say, involuntary commitment, you know, somebody is afraid that if they go in and seek care, they're going to be involuntarily committed into a facility against their will. Within our society continues to be a major problem.

Unstable housing is a huge issue, and that was a big emphasis in this report about the housing issues that we have in people with both mental illness and substance use disorders, and that really impacts their ability to both access care and continue care, right? If you don't have stable housing, you can't consistently get in for treatment. So, you know, if you can get people with these disorders stably housed, then they can get consistently treated. But if they're not stably housed, treatment is extremely difficult.

What role does pharmacy access or medication availability play in these treatment gaps, especially for individuals in rural or underserved areas?

You know, I encounter access difficulties with accessing meds all the time. There’s not a week or really a day that goes by that we don't address this in some form or fashion. As I mentioned, you know, I feel like it starts with housing, right? We start talking. I work in an acute care facility, and we start talking immediately on admission: “Where's this person going to go when they discharge?” You know, so you can't consistently get medications if you don't have stable housing, right? If our plan is to discharge somebody to a shelter, how are they going to be able to consistently access their meds? And one of our shelters now requires patients to go with a month's supply of meds with them to the shelter. We don't have an outpatient pharmacy in our facility. A lot of free-standing psychiatric hospitals do not have outpatient pharmacies. So, we have to send prescriptions a couple of days before discharge to make sure that those meds are there for discharge, and then we have to trust that the patient is going to go by and pick them up.

And there may be prior authorizations that may or may not have been taken care of while they were in the hospital. They may not have the cash to pay their co-pays. There may be shortages, right? We certainly know about shortages that have been very common in pharmacy over the last few years. So, there are any number of reasons that can lead a patient to not get their meds, say after discharge. And they don't have the agency to navigate those challenges, and so they end up going without meds for a few days, and they end up back in the hospital. So prior authorizations are a big one. Cost remains an issue, even though a lot of times the meds we're using are generic. Still, some generics are really expensive, and so cost still remains an issue.