Medication adherence remains one of the most significant challenges in the treatment of serious mental illness (SMI). For patients with conditions like schizophrenia, bipolar disorder, and depression, failure to follow prescribed medication regimens can lead to worsened symptoms, repeated hospitalizations, and a severe decline in quality of life. Behavioral health treatment innovations are tackling this issue by creating tools and strategies to improve adherence and outcomes. According to a meta-analysis, more than half of patients with schizophrenia are nonadherent to their medication, along with 50% of patients with depression and 44% of patients with bipolar disorder. This lack of adherence not only negatively impacts individual patients but also places a heavy burden on the healthcare system.
Fortunately, a growing number of healthcare providers are turning to long-acting injectables (LAIs) as a potential solution to improve medication adherence and enhance patient outcomes. These injectable medications, which provide sustained therapeutic effects over extended periods, could dramatically change the way we treat patients with serious mental illness. Recent research shows that LAIs are linked to fewer psychiatric hospitalizations, fewer suicide attempts, and overall reductions in hospital stays for patients with schizophrenia. However, while the evidence is promising, there are still operational hurdles and some provider hesitancy in fully adopting these medications.
Understanding Long-Acting Injectables (LAIs)
Long-acting injectables are medications delivered via injection, with the medication slowly released over time. This contrasts with traditional oral medications, which require daily dosing. As part of behavioral health treatment innovations, most long-acting injectables for mental health conditions are administered every four to eight weeks, though some formulations may require just two injections per year.
In the context of behavioral health, LAIs are primarily used to treat conditions such as schizophrenia and bipolar disorder. More than a dozen antipsychotic medications in the U.S. are available in long-acting injectable formulations, which are especially beneficial for patients who struggle with the daily demands of oral medication. LAIs can also be used in the treatment of substance use disorders, including opioid use disorder, with medications like naltrexone and buprenorphine being available in injectable forms.
The primary appeal of LAIs lies in their ability to reduce the cognitive and emotional burden associated with daily pill-taking. For patients with serious mental illness, adhering to daily medication schedules can feel overwhelming or even impossible, leading many to stop taking their prescribed medications altogether. LAIs remove this challenge by providing a convenient, less intrusive alternative.
Boosting Medication Adherence and Improving Outcomes
The biggest advantage of long-acting injectables is the dramatic improvement in medication adherence. With these treatments, patients are no longer required to remember to take a pill every day, as the medication is delivered in a single injection every few weeks or months. According to Scott Fears, Chief Medical Officer at Amae Health, “Long-acting injectables predict much better outcomes. Everything from fewer hospitalizations and fewer emergency department visits to reduced symptom burden.” These improved outcomes are not only a result of better medication adherence but also stem from the more stable release of medication in the patient’s system.
One of the key benefits of LAIs is the reduction in fluctuations in drug levels that often occur with oral medications. Traditional antipsychotics, when taken in pill form, can lead to peaks and troughs in medication concentration, causing patients to experience periods of heightened sedation or cognitive fogginess. These side effects can be disruptive to daily life and may lead to a cycle of inconsistent medication adherence. With long-acting injectables, however, the steady release of medication helps to maintain more consistent therapeutic levels, resulting in fewer side effects and more stable symptom management.
Additionally, many patients with serious mental illness may experience ambivalence toward their treatment plan, often feeling disconnected from the need for daily medications. Long-acting injectables, which require far less frequent attention, provide a solution to this dilemma. Many patients are more open to receiving a shot every few weeks rather than taking a daily pill, particularly when they understand the potential benefits of increased stability and fewer hospitalizations.
Decreased Side Effects: A Major Drawback of Oral Medications
Another significant advantage of long-acting injectables, a key innovation in behavioral health treatment, is the potential to reduce the side effects often associated with oral medications. Many traditional antipsychotic medications, particularly at higher doses, can cause drowsiness, sedation, and cognitive dulling, making it difficult for patients to fully engage with their daily activities. These side effects are often more pronounced when patients take their medication in pill form, as the effects wear off between doses, leading to a cycle of sedation and cognitive fog.
In contrast, LAIs offer a more consistent and steady release of medication, which helps to avoid the peaks and valleys of medication levels. As Fears explains, “With long-acting injectables, it’s much steadier. You don’t get that prominent sedation or cognitive effects.” This steadier experience can significantly improve a patient’s quality of life, allowing them to function more effectively on a day-to-day basis while benefiting from the stability that the medication provides.
Moreover, long-acting injectables can help alleviate some of the anxiety or stigma that patients may associate with their medication. By making the treatment process less cumbersome and more predictable, LAIs could offer a greater sense of control for patients, which in turn could help them feel more invested in their care.
The Role of Primary Care Providers in Adoption
While mental health specialists have traditionally been the primary prescribers of long-acting injectables, there is an increasing recognition of the role primary care providers (PCPs) can play in the successful implementation of LAIs. Many individuals with serious mental illness prefer to see their PCPs rather than visit specialized mental health clinics, either due to convenience, personal preferences, or prior negative experiences with mental health systems. This creates an opportunity for PCPs to take a more active role in prescribing and administering LAIs.
Virna Little, cofounder and special advisor at Concert Health, notes that educating PCPs about long-acting injectables can significantly benefit patients who may not regularly see a mental health specialist. “Educating providers about long-acting injectables is helpful because it reduces the difficulty of caring for those patients in primary care,” Little says. By providing training and resources to primary care teams, healthcare systems can ensure more comprehensive care for patients, bridging the gap between behavioral and primary care settings.
Financial Considerations and Insurance Coverage
One of the challenges in adopting long-acting injectables is the cost. While these medications can be expensive, their potential to reduce long-term healthcare costs by preventing hospitalizations, emergency visits, and other costly interventions has become increasingly evident. As healthcare insurers recognize the cost-effectiveness of LAIs in improving patient outcomes, coverage for these medications is becoming more common.
Fears points out that insurance companies are now more willing to cover LAIs, despite the higher upfront costs. “Even though these medications are expensive, the return on investment has been proven quite rigorously,” he explains. By improving medication adherence and reducing the need for acute interventions, LAIs have the potential to save money in the long run.
Challenges to Widespread Adoption
Despite the promising benefits, several obstacles remain to the widespread use of long-acting injectables. One major barrier is the comfort level of healthcare providers, particularly psychiatrists. Many mental health professionals are accustomed to prescribing oral medications and may feel less confident administering injections. Additionally, there is a lack of infrastructure to support the administration of LAIs in some settings, particularly outpatient clinics.
Fears notes that while LAIs are often introduced to patients in inpatient settings, they are not always continued in outpatient care. The lack of a clear transition plan between inpatient and outpatient care can result in patients discontinuing their LAI treatments when they leave the hospital, undermining the benefits of the medication.
To overcome these barriers, education is crucial. Providers must be trained not only in the administration of LAIs but also in understanding the broader benefits of these medications. Moreover, healthcare systems must invest in the infrastructure needed to support the ongoing use of LAIs, including nursing staff and access to regular follow-up care.
A Holistic Approach to Mental Health Care
While long-acting injectables can be an essential part of the treatment plan for many patients, it’s important to remember that they are not a cure-all. As Fears reminds us, “Mental health treatment is holistic, wraparound integrated care. We can’t lose sight of that.” The introduction of LAIs should be viewed as one piece of a broader treatment strategy that includes therapy, community support, lifestyle changes, and other essential aspects of patient care.
At Amae Health, the focus is not just on administering medications but on building a comprehensive care model that addresses all aspects of the patient’s well-being. The goal is to provide both convenience through LAIs and the ongoing support needed to ensure patients lead healthier, more stable lives. By integrating medication with therapy, support systems, and lifestyle improvements, healthcare providers can offer more well-rounded care that addresses the complex needs of patients with serious mental illness.
Incorporating behavioral health treatment innovations like long-acting injectables into treatment plans is vital for creating a more accessible and effective healthcare system. These innovations not only improve medication adherence but also empower patients with more control over their care and reduce the need for frequent hospitalizations. Behavioral health treatment innovations are key to transforming the way we approach mental health care.
Conclusion
Long-acting injectables represent a promising solution to the ongoing challenge of medication adherence in behavioral health, particularly for patients with serious mental illness. By offering a more convenient and stable treatment option, LAIs can reduce the need for daily pill-taking, improve medication adherence, and ultimately lead to better patient outcomes. While adoption has been slow due to provider discomfort and systemic challenges, the growing recognition of the benefits of LAIs—coupled with the potential to reduce long-term healthcare costs—suggests that these medications could play a pivotal role in the future of behavioral health care.
However, to unlock their full potential, healthcare providers must embrace LAIs as part of a broader, integrated care model. This means overcoming barriers to implementation, providing education for both providers and patients, and ensuring that the use of LAIs is paired with comprehensive care. When used as part of a holistic treatment plan, long-acting injectables can help transform the way we manage serious mental illness, improving both the quality of life for patients and the efficiency of the healthcare system. By embracing behavioral health treatment innovations, we take a significant step forward in providing patients with the care they deserve.
