Call for Help: How Pharmacists Can Support Mental Health Care
When it comes to mental health, the widespread belief might be that pharmacists do little more than dispense anti-depression, anti-anxiety medication, but in reality, the role of pharmacists in mental health spans both primary and secondary care and a variety of healthcare settings. In many cases, pharmacists see mental health patients more frequently than their psychiatrists or physicians.
According to the secretary of North-East London local pharmaceutical committee, Hemant Patel, “in community pharmacy we probably see more mental health patients and their carers than anywhere in the healthcare system.
“The hospitals deal with the severe cases — but those with mild-to-moderate anxiety or depression come to the community pharmacy for help.”
A recent review of 18 hospital pharmacy services in mental health care concluded that hospital pharmacists contribute to inpatient mental health care through medication chart review, lab results assessment and medication prescribing; and in providing education for patients and other health care professionals.
Medication review services can optimize medicine use and reduce the use of potentially inappropriate medicines. Pharmacists can also play a substantial role in improving medication adherence and monitoring antipsychotic polypharmacy.
A Cochrane review of eight randomized controlled trials evaluating medication reviews, the researchers found that interventions identified and resolved medication-related problems and improved medication appropriateness in care homes for older people.
A couple of Australian studies examined the impact of medication review led by pharmacists in care home settings, on the drug burden index. Both studies found these medication management reviews significantly reduced exposure of residents to sedative and anticholinergic medicines.
Case conferencing is another powerful tool to incorporate the expertise of pharmacists into mental health care. Bringing together pharmacists, nurses, nurse’s assistants and physicians to discuss patients’ medication regimens has the potential to increase acceptable antidepressant, anxiolytic and hypnotic medicine use and a decrease in antipsychotic, non-recommended hypnotic and non-recommended anti-depressant medicines.
It is no secret patients sometimes struggle with medication adherence, and it is also no secret once released by the hospital, many patients do not come back for follow-ups, but may still visit their community pharmacy. Therefore, pharmacists are in a prime position to collaborate with patients and support their treatment, assess and promote the importance of medication adherence.
One study evaluating a pharmacy based intervention to improve antipsychotic adherence among patients with a serious mental illness, showed increased medication adherence among the patients that received the intervention. The intervention included the use of unit-of-use packaging, a pharmacist education session, refills reminders and notification of clinicians when patients failed to fill prescriptions.
In spite of these encouraging results, pharmacist interventions to promote adherence are not common. There are barriers that continue to hinder the implementation of these services, such as lack of time, lack of skills to treat this kind of patients (whether this is perceived or real), and lack of coordination and/or communication among providers.
Antipsychotic polypharmacy, the concomitant use of more than one antipsychotic agent, is highly prevalent with rates estimated to be between 20-50%.
Because patients tend to visit their pharmacy more than they do their clinic/physician, pharmacist-conducted interviews and medication reviews can help identify adverse inappropriate dosage or side effects of antipsychotic polypharmacy.
Dosage outside of treatment guidelines isn’t the only issue pharmacists may encounter and help solve. Many patients on antipsychotic medicines are also using other psychotropic agents, such as mood stabilizers or antidepressant medicines, which increases the risk of drug-drug interactions and medication-related problems. Antipsychotic treatment can also interact with non-prescription medicines and complementary and alternative medicines (CAMS) (e.g., St John’s wort) which are frequently used by patients with mental disorders. Prescribers may not be aware of these drug combinations, so pharmacist intervention and multidisciplinary collaboration may less the potential harm of these interactions.
Rubio-Valera, M., Chen, T. F., & O’Reilly, C. L. (2014). New roles for pharmacists in community mental health care: a narrative review. International journal of environmental research and public health, 11(10), 10967–10990. doi:10.3390/ijerph111010967
The Pharmaceutical Journal, November 2017, Vol 299, No 7907, online | DOI: 10.1211/PJ.2017.20203915
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