Access to Medicines and Treatment Gaps: A Lived Experience Perspective

 

Access to Medicines and Treatment Gaps: A Lived Experience Perspective

My lived experience of a mental health condition , together with my realization of the importance of adherence to medication, has led me to explore one of the most overlooked reasons behind treatment gaps in healthcare systems. Across the world, millions of people who need effective treatment remain untreated. While this has traditionally been discussed under the broad theme of "access to medicines," I have become particularly interested in one neglected dimension: psychological access to medicines.

Psychological aversion to medicines often develops from distrust of the healthcare system. Negative encounters with healthcare providers, adverse treatment experiences, stigma, and poor communication can distance individuals from recommended treatments, leading to poor adherence and eventual disengagement from care. Conventional discussions on inequitable access to medicines have rightly emphasized high costs, market structures, intellectual property laws, and supply-chain barriers. However, these explanations alone cannot account for why effective medicines remain underutilized even when they are physically available. I believe that the psychological distance people develop from modern medicine and the healthcare system constitutes a significant, yet under-recognized, barrier to treatment.

During my Senior Residency in the Department of Community Medicine at Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, I conducted a qualitative study among healthcare practitioners in Pillangi village, a densely populated settlement located behind South Extension in South Delhi. Despite the village being situated within close physical proximity to government hospitals and health centres, many residents preferred to consult local practitioners who were not formally qualified in modern medicine. These practitioners, commonly known as "Bangali doctors," often possessed registrations from little-known medical councils.

Through in-depth interviews with these practitioners, an interesting theme emerged regarding medication adherence and treatment compliance. The practitioners observed that patients had considerable faith in the medicines they prescribed. One important reason appeared to be that they shared the community's understanding of disease causation. For example, many residents believed that eating mangoes caused impetigo. Rather than challenging this belief, the practitioners accepted it and aligned their treatment explanations with the patients' existing worldview. This congruence between provider and patient beliefs appeared to strengthen trust, improve acceptance of treatment, and encourage adherence.

These observations prompted me to reflect on how psychological barriers to treatment begin long before medicines are prescribed. They are rooted in patients' beliefs about disease causation, expectations regarding illness progression, fears about adverse drug effects, unequal knowledge and power dynamics between providers and patients, judgmental attitudes within healthcare settings, and inadequate understanding of patients' social contexts. When these factors remain unaddressed, individuals may become psychologically distant from healthcare itself.

The consequences of such distancing are particularly evident in psychiatry. Treatment gaps for mental disorders remain among the highest in medicine, with estimates reaching up to 90% for certain psychiatric conditions. Although effective treatments are available, a large proportion of people with mental illness never receive appropriate care or discontinue treatment prematurely. This raises an important question: the treatment may exist, but do patients feel psychologically safe enough to seek it? Unless this psychological barrier is addressed, medicines cannot truly be considered accessible.

Medication adherence is not merely a matter of remembering to take tablets; it is fundamentally built upon trust. Patients are far more likely to continue treatment when they feel respected, heard, involved in decision-making, and supported through adverse effects rather than blamed for them. Supported decision-making and therapeutic partnerships can transform medication adherence from an obligation into a shared commitment to recovery.

In today's era of unprecedented access to information, the medical community must actively create and communicate balanced, trustworthy narratives about disease progression, the effectiveness of treatment, and the management of medication-related adverse effects. Long-term adherence often becomes difficult because patients experience side effects without adequate counselling or reassurance. When there is a trusting relationship with the healthcare system, these challenges can be managed collaboratively rather than resulting in treatment discontinuation. Evidence regarding the effectiveness of medicines should be communicated alongside honest acknowledgement of potential adverse effects and practical strategies to manage them.

Failure to recognize psychiatric symptoms as treatable conditions remains another major contributor to treatment gaps. Building supported decision-making processes, creating responsive care pathways, and strengthening continuity of care can help restore confidence in the healthcare system. Holistic models of care that integrate psychiatrists, psychologists, psychiatric social workers, primary care physicians, community health workers, and peer support workers are likely to provide the safest and most acceptable pathways for recovery. Such integrated care not only improves clinical outcomes but also reduces the psychological distance between patients and the medicines they need.

Ultimately, access to medicines should be understood as more than physical availability or financial affordability. True access exists only when individuals trust the healthcare system sufficiently to seek treatment, accept it, and continue it over time. Psychological access, grounded in trust, dignity, and shared decision-making, deserves recognition as a fundamental dimension of universal health coverage and an essential strategy for reducing treatment gaps, particularly in mental healthcare.

References

1. Kohn R, Saxena S, Levav I, Saraceno B. The treatment gap in mental health care. Bulletin of the World Health Organization. 2004;82(11):858–866.

1. Qin X, Hsieh C-R. Understanding and Addressing the Treatment Gap in Mental Healthcare: Economic Perspectives and Evidence From China. Frontiers in Public Health. 2020;8:463.