Advocacy Groups Influence

Advocacy Groups and the Mental Health Market

Although advocacy groups receive support in various forms from pharmaceutical companies, they do not formally endorse specific medications. They can, however, lobby to have a medication funded by the government, as was the case with clozapine (Clozaril®; Novartis). During the past two decades, advocacy organizations have had widespread impact on the mental health market, not only based on their relationships with health care providers, patients, and legislators, but through the formation of alliances with a variety of market influencers.

Some of the groups and organizations that can influence the market and with whom advocacy groups have formed alliances include:

• Research institutes, such as the National Institute for Mental Health (NIMH) and the National Alliance for Research on Schizophrenia and Depression (NARSAD)
• Guild organizations, such as the American Psychiatric Association
• Commercial websites, such as Medscape
• Federal, state, and local legislative bodies
• Pharmaceutical companies
• Eeducational systems
• Employers
• Housing and social services
• The criminal justice system

Apart from interactions with these organizations, advocacy groups can also influence the mental health marketplace by:

• demanding responsiveness from the provider community to use, or stop using, specific treatments
• educating patients on how to communicate effectively with their therapists about interests or concerns
• educating patients about the importance of treatment compliance
• performing legislative advocacy work to change public policy

All of these areas of influence underscore the importance of partnering with advocacy groups. Forming such relationships is not only beneficial to promoting aripiprazole —advocacy groups will be interested in learning about new therapies — but also because partnering can foster additional relationships and opportunities (e.g., with physicians and other mental health care workers).

Advocacy groups can also impact the market by promoting "best practices" — that is, by spreading awareness of the views held by thought leaders on state-of-the-art approaches to treating mental disorders. For example, NAMI took an active position before Congress to curtail harmful restraint and seclusion practices, a position that gained support from many who had previously turned their back on mental illnesses because of the associated stigma.

In addition, both NAMI and NMHA have supported the schizophrenia Patient Outcomes Research Team (PORT) Treatment Recommendations. These recommendations were based on an exhaustive review of current scientific evidence documenting the most effective treatments for alleviating schizophrenia symptoms and improving recovery. The 5-year study, involving a team of more than fifteen scientists from three major researcher centers, was funded by the National Institute of Mental Health and the Agency for Health Care Policy and Research. The resulting recommendations were the first science-based guidelines for schizophrenia treatment.

In producing the PORT recommendations, researchers organized thirty possible treatments for schizophrenia into seven categories of intervention:

• antipsychotic medications
• additional medications for depression, anxiety, or hostility
• electroconvulsive therapy
• psychological treatments
• family interventions
• vocational rehabilitation
• assertive community treatment

Although the researchers found that many providers are not following these recommendations, advocacy groups have been rallying behind the report to promote a “best practices” approach to treating schizophrenia. Their supportive work, along with related attempts to promote recognition of illnesses, illustrate the powerful impact that advocacy groups can have on the health care market.