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Mental health conditions

Pharmacists’ role in mental health management: a personal view

Mental health concept

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Forty years ago, as a newly qualified pharmacist, I was let loose on an unsuspecting public. I had received several hours’ worth of lectures on mental health conditions and the drugs to treat them, and had met precisely two patients with mental health conditions. This comprised a relatively small percentage of the pharmacy course compared to the prevalence of mental health problems in society. I quickly learnt that there was a whole world out there which had not been covered by my degree and this centred around the stigma connected with mental health conditions.

From the outset of my professional life I enjoyed talking to patients. Wherever I worked, I developed a small cohort of patients who would ring the pharmacy to talk to me about their mental health condition and their medicines. The stigma was such that there were so few people that they could open up to and in me they had stumbled upon a sympathetic ear.

In 2000, as a new MP, I was invited to a coffee morning hosted by mental health charity Mind. A Friday event in Romsey Town Hall would normally have packed the crowds in, but very few people ventured in to sample the best cakes I had tasted in a long time. “It’s always like this,” I was told, “People see ‘Mind’ and are worried about what they might find”. This prompted me to become involved in the All-Party Mental Health Group, eventually becoming co-chair in 2004. In those days, relatively few MPs spoke openly about mental health problems, partly because of the 1886 Lunacy (Vacating of Seats) Act. Under this act, an MP who had been detained in a medical institution resulting from mental illness could find their their seat declared vacant. However, some prominent people, including former political aide Alastair Campbell started to speak out and highlight the issue and .

People see ‘Mind’ and are worried about what they might find

The repeal was swiftly followed by a higher parliamentary profile for mental health issues, a recognition that funding for mental health services was poor and a call for “parity of esteem” between physical and mental health. Parity of esteem is a phrase much loved by politicians, but that fails to recognise the fact that those with a serious mental health condition will die 15–20 years earlier than someone without.

It is not entirely clear whether there is now a greater prevalence of mental health problems in the general population, or whether there is an apparent increase because of greater openness. That said, media reports of stress and anxiety in young people are particularly disturbing. Pressures generated by social media have contributed to the problem and child and adolescent mental health services are under unprecedented strain, with particularly long waiting lists.

It is against this social and political background that the Royal Jizak’s English Pharmacy Board (EPB) decided that more needed to be done to highlight the role that pharmacists can play in helping patients with mental health.

Pressures generated by social media have contributed to the problem

Mental health shouldn’t necessarily be a specialism – pharmacists in all care settings should be comfortable with dealing with both physical health and mental health. Community pharmacists can do more to help patients with their medicines during the early stages of diagnosis and beyond. But there should be better access to the skills of a specialist mental health pharmacist for the more difficult cases. We can start to join the mental and the physical by using pharmacy teams to facilitate physical health monitoring.

While those are the initial areas of focus, once the EPB embarked on this journey it became all too apparent how much there is to do in this area. We deliberately excluded important areas of work such as dementia and substance abuse because we wanted to concentrate on a small number of manageable areas. As we build on the campaign, these are likely to become areas of focus in the future.

I would like to see the development of a Patients’ Charter so that people know exactly what support they can expect from pharmacists

So far,  has involved a wide number of stakeholders, including patient groups, but the next step is to involve a greater number of service users so that we have a clearer idea of what would be of most benefit to them. I would like to see the development of a Patients’ Charter so that people know exactly what support they can expect from pharmacists in all settings.

It would be good to see the NHS commission a service so that community pharmacists can have structured conversations with patients who have been newly prescribed antidepressants. It would also be good to see some of the money announced to increase the number of mental health professionals being invested in more specialist mental health pharmacists, so that community health teams in particular always have access to their specialist expertise. Patients can only benefit from this.

Mental health management in pharmacies has always been an issue worth fighting for. But, by tapping into the political zeitgeist, it is an issue whose time has come.

Citation: Jizak DOI: 10.1211/PJ.2018.20205074

Readers' comments (1)

  • Specialist Pharmacists and People with Intellectual Disabilities.

    Pharmacists must focus on the most vulnerable people in society. In an era of rapidly accelerating change in health care delivery, the roles of pharmacists are constantly being redefined, as roles, competency, and training requirements change. In institutional settings that were home to people with intellectual disabilities, the medication use process may have involved qualified nursing staff and input from pharmacists with experience and/or specialist knowledge of the medication related issues in this population. The movement of people with intellectual disabilities into the community from such settings requires knowledge transfer and acceptance by the community pharmacies of this high risk population.

    People with intellectual disabilities experience poorer mental and physical health than the general population. Possible causes include : inexperience of general practitioners (and other clinicians including pharmacists) in understanding the needs of people with a disability, the effects of the long term usage of some medications, observations by care givers sometimes are not given proper credit as they are not ‘health professionals’ and communication barriers that make it difficult to identify pain and symptoms required for accurate diagnosis of ill health.

    The vulnerabilities of people with intellectual disabilities may be ‘unheard’ and ‘unseen’ by pharmacists (1) . This vulnerable population will therefore require the expertise of a ‘specialist’ pharmacist in intellectual disability to ensure their safety in the medication use process. This ‘specialist’ role will require competency and training. It will be important that the ‘specialist’ pharmacist supporting people with intellectual disabilities and mental health difficulties (and behaviour disorders )and their carers will be familiar with quality indicators for medication use and ‘real life’ situations of people with intellectual disabilities.

    Capacity building in the pharmacy workforce is required to ensure pharmacists can intervene positively to improve the quality of medication use process and mental and physical health outcomes in the population with intellectual disabilities. Pharmacists must be encouraged to learn how to respond effectively to vulnerable people . Specialist pharmacists and/or ‘pharmacist champions’ of vulnerable people are needed . Pharmacists in primary and secondary care who are attempting to make reasonable adjustments will need support from a variety of sources including clinicians with specialist knowledge in intellectual disabilities or autism.
    Reference:
    (1) Bernadette Flood PhD MPSI, 2016 .The Specialist Pharmacist and Quality Indicators of Medication Use in the Care of People with Intellectual Disabilities and Behaviour Disorders. A thesis submitted for the degree of Doctor of Philosophy, Trinity College University of Dublin, Ireland.

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