Mind the gap: Inequalities in mental health care and lack of social support in Parkinson disease

Abstract

Inequalities in mental healthcare and lack of social support during the COVID-19 pandemic have lowered quality of life and increased overall burden of disease in people with Parkinson's (PWP). Although the pandemic has brought attention to these inequalities, they are long standing and will persist unless addressed. Lack of awareness of mental health issues is a major barrier and even when recognized disparities based on race, gender, and socioeconomic factors limit access to already scarce resources. Stigma regarding mental illness is highly prevalent and is a major barrier even when adequate care exists. Limited access to mental healthcare during the pandemic and in general increases the burden on caregivers and families. Historically, initiatives to improve mental healthcare for PWP focused on interventions designed for specialty and academic centers generally located in large metropolitan areas, which has created unintended geographic disparities in access. In order to address these issues this point of view suggests a community-based wellness model to extend the reach of mental healthcare resources for PWP.

Keywords: COVID-19; Disparities; Mental health; Parkinson's disease; Wellness.

Conflict of interest statement

Declarations of interest:

IS: Consultation for Acadia and Acorda Therapeutics

JTH: None

KRC: Serves on advisory boards for: AbbVie, UCB, GKC, Bial, Cynapsus, Lobsor, Stada, Medtronic, Zambon, Profile, Sunovion, Roche, Therevance, Scion, Britannia, Acadia, 4D. Received honoraria for lectures to: AbbVie, Britannia, UCB, Zambon, Novartis, Boeringer Ingelheim, Bial, Kyowa Kirin, SK Pharma. Grants (Investigator Initiated): Britania Pharmaceuticals, AbbVie, UCB, GKC, Bial, Aacdemic grants: EU, IMI EU, Horizon 2020, Parkinson’s UK, NIHR, PDNMG, EU (Horizon 2020), Kirby Laing Foundation, NPF, MRC, Wellcome Trust.

ZM: CME honoraria from Cleveland Clinic and the Movement Disorder Society. Editorial honorarium from Elsevier (assoc. editor for PRD). Advisory fees from Global Kinetics Corporation. Consulting honoraria from: Reckner Health, m-Panels, Amneal, Acadia, Abbvie, Sanofi Genzyme, GB Sciences, and Kyowa Kirin.

HF: Research support from Alkahest, Amneal, Biogen, Michael J. Fox Foundation, NIH/NINDS, Parkinson’s Foundation, Parkinson Study Group, but has no owner interest in any pharmaceutical company. Honoraria from Cleveland Clinic as a speaker in CME events; other honoraria from Bial Neurology, Biopas, Cerevel, CNS Ratings, Covance, Kyowa Hakko Kirin, Partners Healthcare System, Parkinson Study Group, Sun Pharmaceutical Industries (5), Sunovion Research and Development Trust as a consultant. HF receives a stipend from Elsevier as the Editor-In-Chief of Parkinsonism and Related Disorders Journal. He has received royalty payments from Demos Publishing and Springer for serving as a book author/editor.

GP: Consultation for Acadia Pharmaceuticals, Concert Pharmaceuticals, and Cerevance.

Copyright © 2021 Elsevier Ltd. All rights reserved.

Figures

Figure 1:

Barriers to Mental Health and Wellness in PD- Pre-existing barriers related to systemic and disease specific issues as well as those uncovered by COVID-19.

Figure 2:

Wellness Strategies: Emphasizing lifestyle choices, education, social support, and self-agency.