What do 'open' and 'inclusive' mean in mental health and why it is so important?

The following article first appeared on the LinkedIn channel of Dr Tamara Werner-Kiechle, Therapeutic Area Lead for Neuroscience, PH & CVM in Europe, Middle East and Africa (EMEA), Johnson & Johnson. This article has been repurposed for publication on Pharmiweb.

Two senior leaders at Johnson & Johnson (J&), Dr Tamara Werner-Kiechle, Therapeutic Area Lead for Neuroscience, PH & CVM in Europe, Middle East and Africa (EMEA), along with Berkin Gökbudak, Senior Director Commercial Strategy for Neuroscience, PH & CVM in Europe, Middle East and Africa (EMEA), discuss the theme for the 2024 European Psychiatric Congress (EPA) – ‘Mental Health: Open & Inclusive’ and how it is a powerful reminder that while vital progress has been made delivering on the promise of personalised mental health, mental health disorders remain one of the heaviest burdens to our society.

Tamara Werner-Kiechle: Being open and inclusive are integral to Our Credo at Johnson & Johnson and to our ambition in Neuroscience – to ensure a future where we can alter the trajectory of nervous system disorders and eliminate the burden they place on global health.  How would you summarise the importance of the EPA Congress to you and your work, Berkin?

Berkin Gökbudak: For me, EPA24 is not just a vital congress for scientific exchange that informs the future direction of psychiatry in Europe, it’s a pivotal platform for the psychiatry community to address stigma in mental health and reaffirm our collective purpose of ensuring equal and timely access to prevention, treatment, and care for everyone living with serious mental health disorders. Would you agree?

Tamara Werner-Kiechle: Completely. I would also add one more point - by engaging with clinicians and patient advocacy organisations, we can better understand the pressing and evolving challenges in different mental health disorders and drive forward innovative patient-centred solutions.

Inclusivity in mental health is a topic that I am incredibly passionate about. Inclusivity not only enriches scientific inquiry, but also accelerates breakthroughs in mental health.[i] An issue that I highlighted before, concerns the lack of ‘expert’ female clinician voices at congresses and other scientific forums. We must address this – an inclusive scientific community produces better outcomes.

This isn’t just about addressing gender imbalance, and I’m proud of how J&J is addressing disparities in mental health outcomes by including diverse populations in our clinical research, in line with the expectations of the broader clinical science community, which are reflective of subpopulations where rates of mental health problems are rising most,[ii]^,[iii] so we can better understand the issues here and develop more informed and nuanced strategies.

Berkin Gökbudak: We also need to consider the other part of the theme: ‘open’. Whilst depression affects 40 million people across Europe – a value equivalent to the national population of Spain – stigma remains a critical challenge in the depression landscape.[iv]^,[v]

You could argue that stigma is the opposite of being open, as it leads to people suffering in silence, closing themselves off to support, and not being open about their mental health. More than 70% of people with serious mental health disorders remain seriously underdiagnosed due to significant stigma or lack of services.[vi]^{,[vii],[viii]}

Tamara Werner-Kiechle: Absolutely – I think we must collectively work harder to foster environments where individuals feel safe and supported in seeking help, free from the fear of judgment or stigma. It’s what makes me proud to work within a team that is striving to address this through patient-facing campaigns such as Breaking Depression.

Berkin Gökbudak: I love that! As a relative newcomer to the company, this initiative was something that I was aware of, and I was excited to join an organisation that’s confronting stigma head-on. We know that 80% of patients agreed that ‘stigma and discrimination can be worse than the impact of the mental health condition itself.[ix]

A big part of breaking this stigma is providing tools and resources to people living with depression, to help them and their caregivers and support network see there is a way out. Partnerships with the patient community are critical - with key organisations like GAMIAN and EUFAMI. I believe we have a shared responsibility to foster open conversations, raise awareness, and strive to ensure that all stakeholders including HTA and regulatory bodies, understand that the depth and scope of mental health challenges demand a matched response and action to support timely access to innovation across the board.

Tamara Werner-Kiechle: I love this example – it’s so true!  It’s no secret that I am a big fan of digital innovation and its applicability to helping solve some of the biggest healthcare challenges we face. I also think it’s important that, in the interest of being open and inclusive, we explore the ripple effect across every aspect of an individual’s life that mental health conditions can create.[x] This can include health, relationships, employment, and education.¹⁰

Berkin Gökbudak: 100%. We are both in agreement on the urgency and scale of the challenge considering these points. I recently read a report that stated that in the past year alone, half the EU population - 46 percent – experienced an emotional or psychosocial problem, such as feeling depressed or anxious.[xi]

We also know that the incidence of depression is rising in Europe and is expected to become the leading cause of disease burden by 2030.[xii] Big numbers call for big solutions. We continue to advocate for and drive a patient-centred approach to treatment and care. This means tailoring interventions to meet individual needs and preferences, ensuring every patient receives personalised support on their journey to recovery.[xiii]

Tamara Werner-Kiechle: You’ve hit the nail on the head, Berkin. We need to continue to explore novel, comprehensive, and effective solutions to address these pressing mental health challenges.

The way depression manifests in an individual may seem quite variable, but there are potential brain-based reasons that explain the wide differences in symptoms.[xiv]^,[xv] We are exploring the potential of biomarker sciences to enhance our understanding of diseases, aid in patient identification, and accelerate the development of innovative therapies.[xvi]^,[xvii] Specifically, we are investigating how biomarkers might help to identify subpopulations of patients most likely to benefit from a therapy in neuropsychiatric conditions, like MDD and severe MDD.^16,17

Berkin Gökbudak: Yes, we must all double down on ensuring an innovation mindset - which was so evident during the COVID-19 pandemic – continues to be applied across the healthcare spectrum, to ensure that patients have timely and equitable access to novel therapeutic solutions.

Tamara Werner-Kiechle: I’m confident that, by working together, we are entering the golden age of psychiatry, and delivering on the promise of precision psychiatry is within our reach.¹³ With added collective impetus we can accelerate the adoption of advanced technologies, and novel therapeutic solutions, to ensure tailored and personalised interventions so that no one is left behind. There is no health without mental health.

References

[i] Rebello V and Uban KA. A call to leverage a health equity lens to accelerate human neuroscience research. Front Integr Neurosci. 2023 Apr 17;17:1035597. doi: 10.3389/fnint.2023.1035597.

[ii] Sharma A, et al. Improving diversity in medical research. Nat Rev Dis Primers. 2021 Oct 14;7(1):74. doi: 10.1038/s41572-021-00316-8. PMID: 34650078.

[iii] Apers H, Van Praag L, Nöstlinger C, Agyemang C. Interventions to improve the mental health or mental well-being of migrants and ethnic minority groups in Europe: A scoping review. Glob Ment Health (Camb). 2023 Apr 20;10:e23. doi: 10.1017/gmh.2023.

[iv] World Health Organisation. Raising awareness of depression. Available at: https://www.who.int/europe/activities/raising-awareness-of-depression#:~:text=In%20the%20WHO%20European%20Region,or%204.3%25%20of%20the%20population. Last accessed: April 2024.

[v] Mental Health Foundation. Stigma and Discrimination. Available at: https://www.mentalhealth.org.uk/explore-mental-health/a-z-topics/stigma-and-discrimination. Last accessed: April 2024.

[vi] Henderson C, et al. Mental illness stigma, help seeking, and public health programs. Am J Public Health. 2013 May;103(5):777-80. doi: 10.2105/AJPH.2012.301056.

[vii] Faisal-Cury A, et al. Depression underdiagnosis: Prevalence and associated factors. A population-based study. J. Psychiatr. Res., 2022; 151: 157-165. doi:10.1016/j.jpsychires.2022.04.025.

[viii] Thornicroft G. Stigma and discrimination limit access to mental health care. Epidemiol Psichiatr Soc. 2008 Jan-Mar;17(1):14-9. doi: 10.1017/s1121189x00002621.

[ix] Thornicroft G, et al. How to stop stigma: Implementing the lancet commission on ending stigma and discrimination in Mental Health.The Lancet Psychiatry. 2023;11:2;88–89. Available at: https://doi.org/10.1016/s2215-0366(23)00374-7.

[x] Proudman D, et al. The Growing Burden of Major Depressive Disorders (MDD): Implications for Researchers and Policy Makers. Pharmacoeconomics. 2021;39(6):619-625.

[xi] Europa. Eurobarometer. Available at: https://europa.eu/eurobarometer/surveys/detail/3032. Last accessed: April 2024.

[xii] WHO. Global burden of mental disorders and the need for a comprehensive, coordinated response from health and social sectors at the country level. Available at: https://apps.who.int/gb/ebwha/pdf_files/EB130/B130_9-en.pdf. Last accessed: April 2024.

[xiii] Češková E and Šilhán P. From Personalized Medicine to Precision Psychiatry? Neuropsychiatr Dis Treat. 2021 Dec 14;17:3663-3668. doi: 10.2147/NDT.S337814.

[xiv] Zhang FF, et al. Brain structure alterations in depression: Psychoradiological evidence. CNS Neurosci Ther. 2018 Nov;24(11):994-1003. doi: 10.1111/cns.12835. Epub 2018 Mar 5. PMID: 29508560; PMCID: PMC6489983.

[xv] Thng G, et al. Comparing personalized brain-based and genetic risk scores for major depressive disorder in large population samples of adults and adolescents. Eur Psychiatry. 2022 Jul 28;65(1):e44. doi: 10.1192/j.eurpsy.2022.2301. PMID: 35899848; PMCID: PMC9393914.

[xvi] Yen C, Lin CL, Chiang MC. Exploring the Frontiers of Neuroimaging: A Review of Recent Advances in Understanding Brain Functioning and Disorders. Life (Basel). 2023 Jun 29;13(7):1472. doi: 10.3390/life13071472. PMID: 37511847; PMCID: PMC10381462

[xvii] Malik S, et al. Biomarkers of Major Depressive Disorder: Knowing is Half the Battle. Clin Psychopharmacol Neurosci. 2021 Feb 28;19(1):12-25. doi: 10.9758/cpn.2021.19.1.12.