Therapeutic Area Medical Affairs Director, Neuroscience, Janssen UK
There haven’t been any major innovations in mental health therapies since the 1990s. Why is progress so slow, and what can we do about it?
How important is mental health care in UK?
At any one time, one in six people in England are affected by common mental health disorders, which vary in symptoms, recurrence and severity, and ultimately impact individuals and their communities.1 Depression, in particular, is a major contributor to the overall burden of disease on individuals, health systems and society.2
Addressing the needs of individuals affected by mental health disorders is complex. Mental health inequalities in access, experience and outcomes are often linked with wider cultural and societal systems of disadvantage that affect a person’s wellbeing,3 which means a holistic, patient-centred approach to care is needed. However, medications remain a critical option as part of treatment of mental illness.4
The challenges of treating major depressive disorder
A particularly common mental health issue is major depressive disorder (MDD), a severe condition that can have a profound and devastating impact on individuals and their loved ones.4–6
MDD carries a significant societal and economic burden in the UK. In 2007, the estimated cost in England alone was £1.7 billion, a number projected to reach £3 billion by 2026.7,8
Current pharmacological treatments for MDD target the serotonin pathway, which regulates several processes within the brain including mood, emotions and sleep.9 Yet, with up to 30% of MDD sufferers failing to respond to these medications, innovative new treatments are sorely needed.10 There has not been a major treatment breakthrough since the ‘blockbuster’ psychiatric medicines in the 1990s.
What is halting much-needed progress in this area?
Research and development in psychiatric and neurological disorders is notoriously challenging. Issues with recruitment and retention are common in these trials,leading to additional costs and delays.11 Furthermore, the complexity of the biological processes driving these disorders means that central nervous system (CNS) compounds take longer to develop and have lower success rates than non-CNS treatments. By this point, a pharmaceutical company may have already invested significant costs into developing a new compound.12 As such, many pharmaceutical companies have stepped away from neuroscience and psychiatry research because of its complexity and risk of failure.13
Is this the only issue?
No, when new treatments and innovations do emerge, there are still barriers to overcome in order to gain access for UK patients.
Lack of funding is a huge barrier to innovation. Mental health accounts for 28% of the burden on the NHS, but only 13% of its CCG budget.14 Funding allocation through block contracts (where providers are paid in advance) presents another issue, as unexpected pressures such as increased patient demand or cost of care are not taken into account. Block contracts have also been critiqued for not incentivising improved clinical care or innovation in this area.15
Additionally, the National Institute for Health and Care Excellence (NICE) assesses medicines for the treatment of mental health conditions in the same way as medicines used to treat physical health. This process does not factor in the substantial differences between mental and physical health.
Lastly, UK mental health services remain a long way behind physical health services. This lack of parity of esteem means that patients with MDD may be at a disadvantage in accessing the care they need.16 Ultimately, these barriers to innovation lead to a lack of clarity and awareness of suitable treatments and creates challenges for HCPs, patients and their carers.6,17
A unified approach
The NHS Long-Term Plan has outlined its ambition to improve mental health care, yet these proposals must come with adequate resourcing for them to be delivered. 3,16
True innovation will require a multi-stakeholder approach involving the NHS, the pharmaceutical industry, governmental bodies and academia. The needs of carers and patients should be at the heart of any change, to banish stigma, remove barriers in access, and offer the holistic care that is lacking.