Treating co-occurring mental illness and chronic disease


To date there has been little research into treatments for people who have both serious mental illness and a chronic condition. Stephen Godwin believes there are opportunities for pharma in meeting such unmet needs, as well as benefits for patients and payers.

Market researchers are often asked to research a specific therapy area, typically with a view to revealing unmet needs and opportunities. In the main, such projects focus quite narrowly on the condition concerned. Sometimes, when the condition is self-evidently complicated by another illness or demographic as, for instance, congestive heart failure is complicated by hyperlipidaemia, or age, such groups may also be studied in their own right.

Less often considered are the consequences on treatment, unmet needs and even opportunities within the target illness, when it co-occurs in patients suffering with serious mental illness (SMI).

It is important to consider these combinations for two reasons:

1) Cases of concomitancy cause significant cost overruns for health authorities, which in turn affects budget, payers and budget planning strategies

2) The fact that there has been little research to date about treating people whose lives are affected by both SMIs and chronic illness presents a significant 'new' focus for pharma companies for drug and market development.

As an example of how this works, this article examines SMIs combined with type 2 diabetes (T2D).

The combination of SMIs and T2D

The coincidence of chronic illness, such as T2D, complicated by SMIs like schizophrenia, bipolar disorder or severe borderline personality disorder is an interesting study group for several reasons: because the combination is much more common than assumed; because much of the breakthrough medical, psychological and sociological research being done on this specific disease duo is being done in the UK, and because this combination has a clear, documented impact on clinical practice, outcomes and case management.

The numbers


It has been reported that there are as many as one million sufferers of SMIs at any one time in the community alone, many with more than one SMI. This generates a huge cost to England's economy at approximately £105 billion per year. With levels of care becoming more sophisticated, coupled with inflation and scarcity of resources, these costs are expected to double in the next 20 years.

SMIs combined with T2D

Just as cardiovascular morbidity and mortality are increased approximately two- to threefold overall in people with severe mental illness1, when compared to a mean total UK population T2D prevalence of between 5 and 6 per cent, depending on region2, T2D prevalence in SMI patients has ranged from 25 per cent up to 40 per cent in various reports3,4. Interestingly, a Canadian study showed people with schizophrenia had a 74 per cent higher risk of requiring a hospital visit for hypo- or hyperglycaemias compared with T2D patients without schizophrenia5. Likewise, studies have highlighted a significant, clinically-concerning link between schizophrenia and obesity6, which also links to diabetes.

The importance

There is a growing need for the pharma industry to research the SMI/T2D arena, for the following reasons:

• It should come as no surprise that patients with SMIs and T2D are particularly hard to manage. Diseases like T2D need precise, long-term self-management and compliance poses a far greater challenge to SMI patients, often demanding the personal intervention of skilled diabetes nurses, GPs and other care workers at far higher levels than for the non-SMI T2D population. This is a huge resource and cost burden on the NHS and social services, which requires a solution.

• Trends are upward, so in an increasingly technical medical environment, this group of patients is becoming exponentially more resource-intensive to treat.

• According to the Official Journal of the World Psychiatric Association7, 'there is sufficient evidence that people with SMIs are less likely to receive standard levels of care' for most chronic diseases.

• And finally, SMIs often start at a young age and many SMI patients may effectively be 'promoting' more rapid development of their chronic disease through an inability to understand and/or cope with their condition's needs. This progression could perhaps be slowed if the right research is conducted and the right drugs – or right combination of drugs – developed.

Significance for market research, the marketer and building brands

These complications and management difficulties present an entirely new, untapped opportunity for the pharma industry in dealing with the unmet needs of SMI/T2D patients. Such potential extends both to drugs and supporting services, like patient or doctor education, that the industry is able to provide.

Typically, when investigating diseases such as T2D, market researchers understandably tend to use research 'tramlines' to focus on the condition. The danger implicit in this approach is that we may entirely fail to note or recognise frequent needs driven by the additional presence of a complicating severe mental illness. SMI patients' needs are common, complex and largely unmet; addressing and resolving them could provide complementary benefits to physicians and payers, as well as offering opportunities to innovative drug manufacturers:

• For the physician: Being the first drug to market offers a different, better segmented and targeted treatment.

• For the payer: Offering a cost-effective way of approaching and treating a demanding (and growing) sector.

• For the pharma company: Having a unique selling point attached to an agent, potentially also creating a 'halo' effect for the drug's wider usage.

The future: differentiation through development

So, just as there is often an opportunity attached to a problem, an ability to address the needs of patients with SMIs and key chronic diseases may represent a 'new' prospect for both product and service development.

In particular, in markets where brand differentiation is becoming difficult, this type of separation through segmentation should be considered early on in the brand development phase. In a crowded market it will create a point of difference ensuring that all customers' minds are open to a new product, as well as focusing on this important SMI/chronic disease patient group.

In the future, seeking out, researching and analysing the needs of patients with certain organic diseases complicated by SMIs may become more commonplace and a significant 'new' focus for drug and market development.


Brown S, Kim M, Mitchell C, Inskip H. Br J Psychiatry 196 (2010) 116-21.


3 Vancampfort, D. et al. World Psychiatry 12, (2013) 240–250.

4 Mitchell, A J, Vancampfort, D, De Herdt, A, Yu, W & De Hert, M. Schizophr. Bull. 39 (2013) 295–305.

5 Becker, T and Hux, J. Diabetes Care 34 (2011) 398–402.

6 Allison D B, Fontaine K R, Heo M, Mentore J L, Cappelleri J C et al. J Clin Psychiatry, 60 (1999a) 215–220.

7 World Psychiatry, 2001 Feb

About the author:

Stephen Godwin began his professional life as a post-doctoral, serotonin-receptor scientist, evolving through the pharma industry (with Merck and Lilly), UK retail and International Management Consulting into pure marking research on the agency side.

Following 11 years of general healthcare research as a TNS Healthcare Board Director, he joined Isis, (later Synovate) to develop and hone a speciality in international scientific opinion leader research - focused principally on assessing drugs early in the pipeline.

Currently, Stephen is head of Key Opinion Leader Research at THE PLANNING SHOP international.

Read more:

Behavioural economics for healthcare market research and brand communication

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Linda Banks