Lack of linearity
Linear, causal reasoning often fails to provide a significant explanation of mental health conditions because there tends to be many reasons for why an individual experiences a psychological issue - rarely can the (mis)workings of a single neurotransmitter be identified as the sole factor in the condition. On top of this, chemicals and neuronal structures within the brain do not work in isolation, so modifying one may affect many more. This explains why there is often debate about treatment approaches and also means that when it comes to mental health, there aren't any ‘hard and fast' rules. The implication for marketeers is that any single treatment approach cannot be positioned as a panacea and campaign messages should not over promise.

The lack of linearity of psychological conditions makes them fascinating topics for the media to report, especially when it comes to speculation about celebrity ‘breakdown'. Clinical depression is no longer a taboo subject and other topics such as process addictions and anxiety issues can easily fill column inches. What this means is that the media and the public have familiarity with certain psychological disorders and understand that pharmacological treatment is not the only approach - this reinforces the need for delivering credible and balanced messages. Media trivialisation is also an issue to consider - can message pull-through be guaranteed in consumer coverage; can the sensationalisation of patient experiences be avoided?

The debate about treatment approaches also runs to a deeper, philosophical level: hypothesising that all mental health issues can be ‘corrected' by adjusting the balance of chemicals in the brain or improving the speed of synaptic reactions leads to a reductionist conclusion - that human behaviour can be totally explained by physiology. This is a difficult theory for many people to swallow as it implies that the complex layers of social systems surrounding an individual play a very limited role in mental health. Beyond this, it raises questions about the nature of personality and the soul. In order to avoid backlash from consumer interest groups, marketeers should be reluctant to position a pharmacological approach as all-encompassing and should avoid working with spokespeople who will articulate such a position, and should brief their spokespeople not to do so.

Diversity of disciplines
Due to this lack of linearity in psychological disorders, treatment strategies often involve a number of disciplines such as neurology, psychiatry and therapy. This means that in relation to mental health issues, marketeers have segmented specialists to communicate with. Effective communication requires understanding the nuances of clinical practice and attitudinal trends - communicators need to delve deep to understand what ‘switches on' these disparate opinion leaders, how messages should be tailored to them and what communication channels are most effective for reaching them. It is important to get the answers to a range of questions, including: what way do they lean in the CBT vs. neuro-psychological debate; what publications do they read?

Communicating with primary care
This diversity in medical approaches also poses issues at a primary care level - which opinion leaders will have most gravitas with GPs and if implementing a classical information cascade, who should be at the head of it? Here, embracing the holistic approach may be the most sensible strategy.

Other issues to consider with primary care include the over-shadowing influence of the side-effects of old treatments. GPs may still be reluctant to prescribe anti-psychotic medications because first generation treatments had significant side-effects which discouraged patients from taking them. GPs need to be convinced that any medication provides a return-on-investment in terms of delivering effective results for the patient that avoid the patient unnecessarily presenting after a poor experience. Communicators need to consider the heritage of their brand, associations with the class of drug and how safe these treatments are. Convincing and balanced risk/benefit arguments need to be delivered.

Misdiagnosis can pose a challenge in primary care, particularly because of the very short amount of time available for conducting consultations. For example, a bipolar patient may appear to be experiencing depression on the first surgery visit - if a primary care professional sees that patient without context, then an inappropriate diagnosis may result. In this example, the bipolar disorder may go unrecognised because the depression-busting therapy is assumed effective, when in fact it may induce mania. Such eventualities tend to lead to disappointing outcomes for the patient and an extended consultation period. Any educational initiative that eases the diagnosis process in primary care is bound to be received well.

Understanding your internal issues
A communication issue commonly relating to neuro-active medications comes from re-purposing - when an existing compound is extended to treat other conditions that the molecule may not have originally been indicated for. Marketeers working on a re-purposed product need to build on brand heritage rather than scramble the original position, whilst still achieving differentiation.

Communicate with vision
Interestingly, the diagnosis of mental health conditions, such as bipolar disorder, is often based on patient-reported information and observational methodology. A famous study in the 1970s, DL Rosenhan's On being sane in insane places, highlighted difficulties with this approach. Whilst studies relating to the mind have undoubtedly advanced in forty years, data capture in relation to mental health may pose a challenge in another form; patient benefits are subjective and difficult to quantify so it may be difficult to demonstrate cost-effectiveness when economic modelling. This means that products and therapies designed to address mental health issues need to demonstrate their value and social worth in new and compelling ways. 

Communicating in relation to mental health issues requires the vision to understand the motivations of disparate key opinion leaders; the internal challenges associated with repurposing; the very sensitive nature of the individual patient's condition; as well the conviction to challenge societal stereotypes.