Mental health treatment has been transformed in the last 20 years leading to a significant reduction in the number of inpatient beds. The treatment of mental health is unrecognisable from the asylums of old, thank goodness!
This transformation has led to a major shift in care provision, with many patients with mental health problems being seen by the GP with limited specialist input. GPs have raised concerns about this change, reporting a need for increased knowledge and competence and improved co-operation between primary and secondary care. Patients are also concerned, with 22% reporting they needed more specialist input1.
My question is – How quickly did pharmacy adapt to this change in care provision? As a mental health specialist pharmacist I recognised there was a significant difference between the services I offered to inpatients compared with those seen with Community Mental Health Teams (CMHTs). I continually asked myself the question:
If I required hospitalisation for a mental health condition for a significant length of time, leaving family, friends, job, social life etc., how easy would it be to simply integrate back into society post discharge and what or how could pharmacy assist with this transition?
And so the challenge began in transforming aspects of the pharmacy provision, to include patient within CMHTS and those ‘revolving door’ patients with complex needs in GP practices.
In 2016 we started a pilot project with a pharmacist and technician working with GPs to address problems patients on the Severe Mental Illness (SMI) register encounter.
A total of 104 interventions were made over a 9 month period, which demonstrated gaps in the system and clear unmet needs by patients and primary care staff requiring support.
Similarly, work began in CMHTs too. The pharmacy team (pharmacist/technician) targeted two groups:
Primary care referrals to CMHT
Over a period of 6 months 62 referrals were sent directly to the pharmacist. Of these, 95% were dealt with directly by the pharmacist and required no further secondary care input. In the absence of this role theses referrals would have added to the CMHT workload.
- switching antidepressants
- Advising how to safely reduce or stop medication
Review of patients prescribed long-acting antipsychotic injections
Often patients with schizophrenia are prescribed this type of medication more frequently and this form of medication is often not reviewed adequately. Working with one consultant 30 patients prescribed depots were reviewed and 19 patients were identified as being able to change their medication or care which included
- Reduced frequency of depot
- Switch to oral
Challenges and Next Steps
We need continued funding for these progressive roles to go on developing services that enhance and improve the quality of care for patients with mental illness.
It’s essential that staff employed in these roles are passionate, enthusiastic, motivated and not afraid of change or pushing the boundaries. It’s often through many challenges and risk taking that real progress is made.
If you identify an area that you feel you can make a difference to patients care – go for it, you never know it may have a lasting impact on patient care and service development. My challenge to you is be curious!
- Mental Health Foundation. Fundamental Facts About Mental Health 2016. https://www.mentalhealth.org.uk/sites/default/files/fundamental-facts-about-mental-health-2016.pdf (accessed 24 Oct 2017)