NCBH Guidelines and LAI Therapy for Schizophrenia

Transcript: John Kane, MD: Dawn, what do you think about the [National Council for Behavioral Health’s] guidelines regarding the use of long-acting injectables LAIs?

Dawn I. Velligan, PhD: The national council is a group of mental health organizations and community mental health centers that represent the frontline people who are dealing with schizophrenia every day. Their guidelines are: use it often, use it fast, offer it to anybody. It’s recommended with the first episode and anybody who is not doing well. The council is saying that this is a first-line treatment that we want to recommend to our patients.

I want to say there is a way to offer long-acting injection to people in a shared decision-making framework that doesn't make you paternalistic. If you present the information to them, to their families, and if you work with them, they can start to realize that this is the foundation of their recovery. If you tie it to their recovery goal and what they want to be and what they want to do, it makes it much easier for them to accept. The national council guidelines are centered on how do you use LAI to help people recover. There is a need to use it more often and offer it to anybody with schizophrenia who comes through your door. If you're going to offer an antipsychotic, offer a long-acting one. The national council’s guidelines do that.

Sanjai Rao, MD: One of the driving forces is clinician ignorance, people who were trained in a particular model and have difficulty adjusting to our new model and accepting the new evidence that we've discovered. Many clinicians believe that they are not going to be able to successfully offer a long-acting to a patient. They'll tell me, “I don't offer it to my patients because I don't think they're going to want it.” This is alarming because we have evidence suggesting that is not correct. If you offer it in a collaborative fashion, most patients actually would consider it, and many of them will take it. We know that these clinicians are wrong about what they're suspecting.

One big question is how to move them in the direction of listening to their patients. I remember 1 [clinician] in particular to whom I said, “Why don't you just try it? I know you think your patient is going to say no, but how about the next time you see a patient with schizophrenia, or the next 10 times, just go ahead and offer it and see what happens.” I remember following up with him about a year later, and he said he had completely changed his practice. Even though he didn't believe it was going to work, he started offering LAIs to all of his patients in a positive way, and was completely shocked when the majority of them accepted the LAI from him. And he did not think that that was going to happen.

Erin C. Crown, PA-C: As providers we have a duty to let our patients know what their options are. They don't know, and it's not their responsibility to know. It's our responsibility to educate them on what their choices are. We need to offer guidance that is going to be in their best interest, taking all things into consideration.

Transcript Edited for Clarity