Fixing the Gaps in Care for Serious Mental Illness, with Michael McGuire, Pharm.D.

Michael McGuire, Pharm.D.

Credit: Belmont University

As a psychiatric pharmacist with over two decades of experience, Michael McGuire, Pharm.D., knows firsthand how broken the U.S. mental health system is — especially for people living with serious mental illness (SMI). In this wide-ranging interview, McGuire shares why care team coordination is critical, how insurance and workforce issues block access to treatment, and why, despite everything, he remains hopeful about the future of mental health care.

Why is coordinated care so important for people with SMI, and what does that actually look like in practice?
Michael McGuire, Pharm.D.: Let me start with a bit about my background — it helps frame the answer. I’m a pharmacist who specialized in mental health after pharmacy school. I now split my time between a university and a 130-bed acute behavioral health hospital, where I primarily care for patients with SMI: schizophrenia, bipolar disorder, chronic depression and severe anxiety. These are some of the most complex patients, often on multiple medications and in need of coordinated interventions.

One of our biggest challenges is that the system is deeply fragmented. Mental health providers, primary care physicians and substance use specialists often work in silos, which makes care coordination nearly impossible. That’s why it’s critical for patients to have a team — because the system is not navigable on your own. Even as a professional, I find it difficult. My own child lives with mental illness, and navigating his care has been incredibly frustrating. Patients need advocates to help them through this system — people who can connect the dots for them.

What should patients or caregivers do when mental health and physical health providers aren’t aligned?
MM: They have to advocate for themselves — though that’s easier said than done. Organizations like National Alliance on Mental Illness (NAMI) or Mental Health America can help, but many families don’t even know they can switch providers if the fit isn’t right. For example, we recently had to change my child’s therapist after residential care because the one we were assigned wasn’t a good fit. Most people don’t realize they have the right to ask for a different provider. But again, for someone with SMI who doesn’t have a parent in the field? It’s a much harder road.

Insurance is another major hurdle. What are some of the biggest barriers you see?
MM: Formularies are a huge issue. Just this morning, we had to switch a patient to a less effective long-acting injectable because their insurance wouldn’t cover the one we wanted. Mental health conditions are heterogeneous. What works for one patient may not work for another — this isn’t hypertension, where most drugs are interchangeable. Prior authorizations and denied coverage lead to nonadherence, hospital readmissions and an exhausting cycle that’s preventable.

What keeps you motivated?
MM: The patients. Society has largely abandoned people with SMI — we tolerate care gaps in mental health that we’d never accept with cancer or heart disease. But these patients matter. I’ve been doing this for 25 years, and the medications today are significantly better than what we had even a decade ago. That gives me hope.

Why do you think stigma still persists in 2025?
MM: Media representation is a big part of it. People still associate schizophrenia and bipolar disorder with violence and danger, even though most people with SMI are far more likely to harm themselves than others. And then there’s the language — terms like “schizophrenic” instead of “a person with schizophrenia.” That kind of language makes the illness someone’s identity instead of something they live with. We’ve made progress in talking about anxiety and depression, but we still hide severe mental illness in the shadows.

Is there anything else you’d like our audience to know?
MM: We know how to treat schizophrenia. We have providers. We have medications. But we lack access, housing, coordination and, most importantly, funding. The U.S. created a community mental health framework decades ago but never funded it properly. If those resources get cut further, it’s going to get even worse. This is a solvable problem, but only if we treat it like the public health priority it is.