Behavioral health care is evolving, as care providers are coming to understand that a generic approach doesn't meet the diverse needs of all patients. This article delves into insights from Carelon Behavioral Health on effectively managing serious mental illness (SMI) by integrating therapy and medication, and information shared during a CarelonRx Connects webinar on the complex yet essential realm of behavioral health.
What is serious mental illness (SMI)?
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 psychotic disorders, but can also include treatment-resistant depression, anxiety disorders, eating disorders, and personality disorders if the degree of functional impairment is severe.
SMI significantly disrupts an individual's ability to function at their healthiest levels across various life dimensions such as work, social life, and self-care. An SMI diagnosis brings with it many implications that extend beyond mental health, too, influencing physical health due to a higher prevalence of physical illnesses within this population.
Understanding SMI prevalence and costs
It is crucial for plan sponsors to recognize that individuals with SMI are battling long-term conditions, often necessitating multiple treatment approaches and care providers over time. These conditions typically require active, ongoing management to treat symptoms, maintain stability, and prevent relapses. The prevelance of SMI may come as a surprise:
• In any given year, approximately 1 in 20 or 5% U.S. adults experience serious mental illness.
• In 2023 alone, among adults aged 18 or older in 2023, 5.7 percent (or 14.6 million people) had SMI in the past year.
The associated costs of serious mential illness may also be surprising. A recent article from Carelon Behavioral Health states:
“Mental healthcare is becoming one of the most expensive challenges of our time — impacting individuals, businesses, and the economy. Rising costs and affordability concerns are straining both individuals and providers. A recent Columbia Business School study explains how mental illness costs the U.S. $282 billion a year — rivaling the impact of the average economic recession."
SMI treatment approaches and medications
In the treatment of serious mental illness, medication often serves as the cornerstone, effectively managing symptoms that might otherwise overwhelm an individual's ability to function. Medications, such as antipsychotics and mood stabilizers, address the biological aspects of SMI, enabling patients to regain the stability needed to engage in therapeutic practices and everyday activities.
However, these medications are not without challenges. Some psychiatric symptoms require specific medications which can lead to side effects impacting metabolic and thyroid functioning, necessitating regular monitoring. Connected pharmacy care becomes essential here. By providing active management and support, including regular check-ups and testing aligned with medication needs, pharmacy care teams help ensure medications are safe and within therapeutic ranges, preventing potential complications.
Moreover, combining medication management with structured therapy presents a well-rounded approach to mental health care — medication reduces acute symptoms swiftly, while therapy fosters long-term coping strategies. This dual approach results in faster improvement, better adherence, and more sustainable health outcomes.
Connected pharmacy care for employees with SMI
Effective SMI management hinges on the cooperation between patients, caregivers, and diverse healthcare professionals. Treatment typically involves antipsychotic medications for conditions like schizophrenia, and mood stabilizers for bipolar disorder. Importantly, psychotropic medications help manage symptoms but don't change life circumstances, thus expanding cognitive capacity for individuals to engage in meaningful therapy sessions.
As part of a connected care strategy, our teams closely monitor patient data, proactively reaching out to support pharmacy needs, which can lead to cost savings and improved patient health outcomes. By prioritizing the comprehensive care of individuals with SMI, employers and plan sponsors can better support the long-term wellness and productivity of their members, assuring quality outcomes that benefit everyone involved.
Connected pharmacy care enhances quality care outcomes, which are essential for health plans to measure and report, ensuring that employees with serious mental illness receive the health outcomes they deserve.
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