Innovating to improve mental health across the globe

Paul Janssen, M.D.,—who founded Janssen Pharmaceuticals, which has been part of the Johnson & Johnson family of companies since 1961—synthesized the first schizophrenia medication approved for treatment of patients at home in 1958.

Johnson & Johnson has remained fully committed to building on his legacy. The company has developed more than 20 medications and innovations for nervous system disorders, with three on the WHO Essential Medicines List. In 2019, the company brought to market the first new mechanism of action approved for depression in 30 years.

More recently, the company has made strides in developing treatments for schizophrenia.

“We have invested a lot in developing long-acting injectables: We started with moving from daily dosage to less frequently dosed, professionally administered medications to medications now dosed several months at a time,” says Srihari Gopal, Senior Director, Compound Development Team Leader, Janssen Pharmaceutical Companies of Johnson & Johnson. “Last year we were able to lengthen that to twice a year.”

The ultimate goal with each iteration of the medication is to make it easier for patients to adhere to treatment regimens, and in turn, reduce instances of symptom recurrence and frequency of hospitalization, giving patients and caregivers alike the potential for a life less defined by schizophrenia medication.

“What we know is that the fewer and fewer times patients have to remember to take their medication, the less burdensome their treatment regimen is,” Gopal says.

It wasn’t that long ago that the world thought of leukemia as a single disease. As such, every case of this blood cell cancer was treated with the same chemotherapies and radiation. Today, we know that leukemia is a category of many diseases—and treating it with precision based on the type of leukemia a patient has is key.

Johnson & Johnson envisions a world where the same is true for nervous system disorders.

Already, the company is investigating a more precise treatment model of depression. “The issue in depression is that you don’t really know what drug to give a patient at first,” Gopal says. “On average, patients cycle through two to three medications before they find a combination of medicines that works for them. In spite of that, you still often experience residual symptoms,” which are those that persist even after cycling through multiple different treatments.

There are two Johnson & Johnson drugs for depression currently in phase 3 trials that aim to change this paradigm.

“Right now, patients’ response rate to standard antidepressants is only about 20 to 30%,” Gopal says. “We think that by assessing residual symptoms such as insomnia or anhedonia (the inability to feel pleasure), we can find the right drugs for them sooner, rather than cycling through several different medications first,” Gopal says.

The full realization of precision medicine for mental health will go beyond selecting patients based on their symptoms and move toward integrating additional data including genetics, biomarkers, digital health information and neuroimaging to understand which people will respond to which treatments and, further, who needs treatments that do not even exist today.

“Beyond precision medicine within a disease, we know that across various mental health diagnoses, such as bipolar disorder, major depression and schizophrenia, there are both shared symptoms and shared biology,” says Gayle Wittenberg, Vice President, Neuroscience Data Science & Digital Health, Janssen Research & Development, LLC. “By taking a data-driven approach that transcends diagnosis, we expect to find treatments that work across multiple diseases along dimensions of shared pathology. Once we have these treatments, we can then leverage artificial intelligence and machine learning, applied to large data sets, to find the patients who could benefit.”

One way Johnson & Johnson is enabling these advances is by integrating data from wearable, off-body and smartphone devices that measure activity, speech, behavior and cognition to try to identify patients who will respond to different targeted therapies.

“We can learn from patients in our clinical trials, but, ultimately, the most impact comes from making the link to what happens in the real world,” Wittenberg says. “Enabling precision medicine requires a new paradigm where richer patient data is collected as a part of routine care. We expect digital measures to be one key pillar in moving the field forward and driving greater patient impact in the future.”

Research shows that discrimination against those with mental illness remains a significant culprit behind the treatment gap across the globe. It’s impossible to transform care without first raising awareness that those struggling deserve better treatment, Kramer says.

Part of the reason this is so important is that mental illness is the only chronic illness that primarily affects young people. Unlike heart disease and cancer, which tend to strike older generations, mental illness can begin in adolescence and follow people throughout their lives—meaning it can take a toll on their prime years in the workforce, potentially affecting their employability and income.

That’s why Johnson & Johnson is investing in solutions for people in recovery. Take the Workforce Re-integration for Persons in Recovery of Depression program in Singapore. Supported by Johnson & Johnson Impact Ventures (JJIV), it’s working to demonstrate that, with tailored support models, people in recovery can rejoin the workforce, maintain their employment and lead healthier lives.

“Even though there is recognition that depression is an issue, until very recently there hasn’t been much in terms of encouragement for employers to hire people in recovery from mental illness,” says Wen Yi Tan, Southeast Asia Lead, Global Community Impact, Johnson & Johnson. “The norm is that if you declare you have a mental health issue, you might not get past the first interview.”

The pilot program has three aims: providing training and job-placement services for those in recovery, training employers in the needs of those recovering from depression and, finally, providing community for participants in the program through a coworking space. “It all sounds fairly logical and straightforward, but it did not exist before this,” Tan says.

Addressing discrimination against people with mental illness is also of paramount importance because of the significant race-based health disparities that exist in the United States in particular—including disparities in access to mental healthcare.

In November 2020, Johnson & Johnson announced Our Race to Health Equity, a $100 million commitment over five years to help eradicate racial and social injustice as a public health threat.

Black nurses in the U.S., for instance, are not only subject to the considerable stressors of their profession, but also to racism-related stress. Through a partnership with the National Black Nurses Association (NBNA), Johnson & Johnson is working to help Black nurses build the resilience they need to combat this stress through educational workshops with local NBNA chapters and free, licensed, in-state virtual therapy.

The more support that healthcare workers receive, the better the support their patients can receive in turn.

Virginia Smith-Swintosky, Ph.D., Mental Health Franchise Leader, Global Public Health, Johnson & Johnson, and team are currently piloting a program in partnership with the Rwandan Ministry of Health to address the urgent need for mental health understanding and services in the country by focusing on three key areas: improving data collection so the government can understand the true scope of the need, bringing mental healthcare into communities outside of urban centers by training community healthcare workers and enabling access to essential and innovative medicines.

So far, the partnership has led to the creation of the first National Mental Health Survey in Rwanda, trained 50,000 community health workers on the signs and symptoms of mental illness through an innovative phone-based training program and successfully transitioned a group of schizophrenia patients who participated in a Janssen-sponsored clinical trial to long-acting injectable antipsychotics developed by Janssen.

“The hope is that this will be a model that can be scaled to other low- to middle-income countries,” Smith-Swintosky says, adding, “we have a really bold ambition, which is to create access to quality mental healthcare for all people living with mental illness across the world.”