Welcome to “Enjoy the Journey.”

I’m Erin Lanciani, Chief People & Experience Officer at Sage Therapeutics. Coming off 2020 made me really reflect on the journey we have been on at Sage. I often get calls and questions about that journey, so thanks to COVID eliminating my commute and travel time, I had additional time to reflect and write about our journey as a biotech company. These articles tell the story of Sage over the last seven years – the highs and the lows. From start-up to commercial, recruitment to reductions, and negative data to bouncing back, you’ll see for yourself how we thought about and handled each chapter of our story, keeping our people at the heart of all we did. I tried to make the articles short, easy to follow, and very practical. I hope you find them interesting and they help in some way with your journey. I’d love to hear from you – your thoughts, stories, and advice once you’re done reading each one.

In this chapter, we’re looking at how we can break the stigma around brain health – from the inside out.

The Next Pandemic.

We’re living through strange times. A global pandemic, political upheaval, widespread demands for greater human rights. We’re hearing: “mental health could be the next pandemic.” In the short term, depression rates in young people (and many others) are skyrocketing, with lives rerouted in ways nobody imagined. It’s scary to think that we don’t know the long-term implications of the times we find ourselves in.

Still, if nothing else, it’s making people start to think differently. The pandemic, and movements like Black Lives Matter and Me Too, have contributed toward opening the conversation about brain health exponentially. We’re seeing major Hollywood movies and stars tackling issues of brain health; TV shows addressing once-taboo issues like PPD; even the British royal family has been involved in the conversation.

It’s sort of a “clean slate” moment. With all the awareness and discussion, it feels like we’re getting ready for a new beginning as a society. We have a long way to go, but we’re taking steps in the right direction by simply engaging in the conversation.?

It’s great to think that we at Sage – and other companies making medicines – have contributed to this conversation, even if just in a small way. As people continue to wake up to these important subjects, we’ll continue not only pursuing our mission of making medicines that matter but raising awareness of brain health, helping create spaces where it’s okay to not be okay.?

At Sage, we’re working to break the stigma around brain health from the inside out. This chapter of Enjoy the Journey follows how that work began, how it evolved over time, and how others can get involved in the fight against the next pandemic.

Silence Sucks.?

In 2017, following our research breakthrough with Sage-547, now known as brexanolone, in the treatment of Postpartum Depression (PPD), we started to work on disease awareness campaigns aimed not just at physicians who see new moms, but at moms who may be suffering from PPD, or might suffer from it in future.

One of the big problems with mental health issues is that people are reluctant to talk about them; there’s still stigma attached. It’s an outdated view, but it’s still commonplace – that mental health isn’t as important, severe, or treatable as other health conditions. People consider it more like an identity (“I’m depressed”) than a treatable condition or illness (“I have a broken leg”). Because it’s complex with no “obvious” cure-all, a mental health condition can often remain undiagnosed, untreated, and unresolved. ?Even if it is treated, there is a dire need for new medicines that work better and faster with less side effects.

That’s why we, and now many others, refer to these very real, and treatable illnesses, as “brain health.” The brain is an organ, and it’s easier to accept that brain health is physical, real, and treatable. We’re trying to encourage more people to make that shift, seeing a brain health issue not as an identity, but as a treatable (hopefully one day curable) condition.

Our investigations into PPD also found a very specific and difficult issue shared by many moms; they felt they couldn’t speak up. Many also felt their physicians weren’t listening if they did! We wanted our campaign to raise awareness across the board, to discourage silence on the issue, and signpost advocacy organizations that could help.

That was what our award-winning Silence Sucks campaign was all about. It focused on how moms felt bad speaking up about PPD (and the associated guilt they felt when they were supposed to be enjoying what many women describe as “the happiest time of their life”). It was aimed at letting them know that it’s okay, that there’s help out there, that there are people who’ll listen and others feeling the same way. Admittedly, it was provocative (some say “controversial”), with its eye-catching imagery of a mom with tears in her eyes and a pacifier in her mouth. Whether people loved it or not, Silence Sucks certainly got the PPD conversation going. In typical Sagean “Do Big” style, we put it everywhere - it was on pretty much every bus board across Boston! We saw a huge amount of traffic to patient advocacy organizations, with people trying to learn more about PPD – exactly what we wanted.

We also developed a patient and physician website aimed at educating on the telltale signs of PPD. At the time there was no approved treatment for PPD; ZULRESSO? (brexanolone) which was subsequently approved in 2019 was truly a breakthrough medicine. It was important we were raising awareness for moms and the people around them (including physicians) to recognize PPD and establish interventions to help. After launch, realizing some pieces were missing to get Moms activated, we developed a “KnowPPD” campaign and we recently launched “Check on Mom” which encourages expectant moms to make a plan for PPD; everybody makes a birthing plan, everybody decorates their nursery, but nobody plans for PPD. In the US, about 1 in 8 mothers experiences symptoms of postpartum depression. ??

Our campaigns don't just raise critical awareness of the symptoms of PPD and open the conversation up, they are also great for increasing brand awareness in the talent market. We had people tell us they saw the “Silence Sucks” campaign and it was a fantastic way to spread our mission and purpose.

Breaking the Stigma – From the Inside Out.

Reviewing Our Benefits Offering.

The conversations we were generating around PPD opened the door within Sage to focus on a wide range of mood and brain health disorders as our development efforts evolved. Each of us considered it a huge opportunity. A little biotech impacting the world felt like too big a challenge, realistically. But knowing our conversations could impact one, two, three lives... and then their conversations could impact one, two, three lives... the chain reaction we could cause was exciting, and it lit up our desire to become champions of brain health not just externally but internally for our employees. After all, if we wanted to raise awareness outside of Sage, we had to break down as many barriers as we could inside of Sage first. We call this breaking the stigma from the inside out.

As we do at Sage, we got together and we planned, breaking the problem down into areas we could tackle. We asked “What does breaking the stigma look like? What are we trying to achieve??

We broke it down into 6 core areas where we could truly affect change internally: Wellness, benefits, social, education/training, communications, and digital. I've attached the plan here as a downloadable takeaway so you can see what each area comprised. From workouts to brain health days, from paid family leave to presentations and discussions with mental health advocacy groups, and from support reimbursements to smartphone apps with paid meditation subscriptions, we reviewed and updated our entire benefits package, [1] ensuring we had plentiful resources for brain health support. We continue to evaluate and integrate new opportunities to this day and going forward.?

It’s Okay to Not Be Okay.

Understanding brain health and promoting a non-judgmental environment is a key part of our diversity and inclusion efforts. People can feel excluded if they have a brain health disorder, or that they won’t have the same opportunities to succeed. We categorically want people to know that isn’t true at Sage. We do a lot of storytelling around various areas of brain health, and we often tie this in with key events throughout the year, like Coming Out Day, Veterans Day, or International Women’s Day. Even back at our ZULRESSO launch, we had employees sharing their personal experiences of PPD. It was very moving and authentic, and it set a scene of – it's okay to not be okay!

We also thread this right into our recruitment. We look for people who are passionate about our mission, which ties in naturally to people who want to break the stigma surrounding brain health. And quite often people feel this sort of passion because they’ve personally experienced brain health disorders in some way. So we all have this connected sense of pride in our understanding of these issues and our mission to help others who are suffering.?

The leadership team at Sage really makes it very easy to share. Whether that’s through personally leading by example, or through more general communications, they’ve cultivated an environment of openness and trust where people can share what’s going on in their lives and get the support they need from the people around them.

Take A Different View.

Something we approach differently at Sage is the phrase: “We’re a work family,” which a lot of companies say! Because we strongly believe that your co-workers are not your family, even though you may care about them a lot. Your family is your family. Instead, we have a very strong family-centricity. We support each other, knowing we are each the product of our life experiences. We understand that people might have things going on outside of work that can affect them inside of work – marriage, children, family, friends, responsibilities, etc. We don’t believe “work-life balance” is a complete term that captures everything, because work is a part of life, and life is a part of work. We believe in understanding how all elements of a person’s life come into play in their day-to-day actions, emotions, and performance.

Another thing we approach very differently is time. We do not believe work has to happen between 9 and 5. Our response to the COVID-19 pandemic has influenced this, definitely (you can read more about our flexible working philosophy in later chapters), but it’s also down to our general approach of hiring purposeful, smart, driven, and passionate people. People who are committed to our mission. We don’t burden them with unnecessary rules and processes. The most helpful thing we can do to enable them to do their best is to get out of their way and let them do their thing! And when they need to go collect their kids or get their flu shot or visit a relative, we step back and say “go!” - knowing the purposeful work will always continue.

When we review how we operate as a company (which we do on a regular basis), we’re always looking for what else we can bring in to enable each other to do our best work and support our well-being. We have even built that philosophy into our working space. It really is about listening to what people want and exploring how you can marry that up with your working environment or benefit offering. ?

How Can Other Companies Get Involved?

Breaking the stigma surrounding brain health isn’t just the responsibility of those working in the brain health space. It’s a wider responsibility for every company. Realistically, companies have been making accommodations for various health issues for decades (as they should!), but brain health is the area that needs to be focused on next. As I wrote earlier in this chapter: “mental health could be the next pandemic.” It has to be high on your priority list when it comes to your people.

I believe that most companies do care about the well-being of their employees. This is about going further, to create an environment of openness and discussion people need to be able to share their experiences.

It all starts with openness. At Sage we do have the benefit of already working in the brain health industry, but that doesn’t mean other companies can’t do this too. Give your employees space to share. Get your senior leaders to share and lead by example, if they feel comfortable. Let people know it’s okay to not be okay, and that you understand their life outside work has a big impact on their life inside work.

Know that everyone has a different comfort level, too. Creating the space to share doesn’t mean that everybody will immediately pour their heart out. It’s all part of a journey of education and normalization.

Load up on your resources, too. Make tools available to your people so they can reach out for the help they need. As an example, all Sageans have access to the Ovia app, which focuses on fertility and pregnancy. We actually do work with Ovia to build PPD resources and support into their offering. This isn’t an obvious “mental health advocacy organization” but we recognize this can be a difficult or stressful area in people’s lives.

Sometimes it’s just about sitting down and thinking about your people as just that – people. People with lives, complex emotions, and demands on their time from all areas. Understanding the different stress factors in the lives of other human beings can give you all the insight you need to create a supportive, open, caring environment where people can truly bring their whole selves to work.

Finally, this is an area where I’d love you to reach out and talk to me. We want to share the successful model of what we’ve achieved at Sage with as many other companies as possible, so we can continue to open up the conversation about brain health. We don’t want to be the only champions of brain health – we want that to be the standard, at every company! Drop me a message if you want to get the ball rolling.

Sage Advice

1. Take brain health seriously: Today’s world is more open and exploratory than ever on this subject. It’s part of your responsibility as an employer to address it in the same way you’d address more “traditional” physical health conditions. Jump in and help lead in the fight against brain health disorders. Don’t get left behind.
2. Review your support offerings on a regular basis: Just because it was right last year doesn’t mean it’s right now. People’s lives are changing all the time. You may need to pivot to make sure you’re providing the space and support they need.
3. Communicate, communicate, communicate: Keep asking your people what they need, and let them tell you! Listen to them and act upon the information they share. There’s no better way to help them feel supported and cared for.

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[1] When the COVID-19 pandemic hit, we did something similar. I won’t go into too much detail here; you can read about it more in Chapter 5.