I decided to try mental health pharmacy on for size, for six months. That was 15 years ago now. It was a good fit.
When working in community pharmacy, I looked at a list of psychiatric drugs on prescriptions (usually combinations the BNF has a black dot against) and felt out of my depth to challenge it. I imagine there are a few of my colleagues who do this now.
Mental health problems are hard to measure – diagnostic criteria overlaps, you can have more than one at a time and the evidence base is… lets say RCTs contain a few less than the 18,000 subjects you see in a trial of a statin.
My first experience of someone with acute mental illness was in the old rehab unit two months after starting. Asked by the nursing staff to “make them take their Quetiapine” I was left alone in a bungalow with a woman who was clearly psychotic, whom I’d never met before, and who really didn’t want to take medicines for a condition she didn’t believe she had. It didn’t exactly go well. Unsurprisingly she didn’t take her Quetiapine.
This was a long way from patient centred care. Thankfully things have moved on.
Working in mental health is not without its challenges. But being part of a team that helps individuals find themselves again after their mind has lost its way is rewarding, fascinating, sometimes entertaining and occasionally heartbreaking.
And I love it.
In the acute service I help the team, which obviously includes the patient and their carer(s), find a treatment that can fit the individual. Using resources on the NHS Inform site to help people see what options they might have, we start people on their road to recovery.
Mental health problems are common but most people with them are not in hospital. We will meet them wherever we are – from ITU, medical wards, maternity, nursing homes, GP surgeries, in our pharmacies and at home. There are many potential roles for us.
Mental and physical health is interconnected in the same way that the head is attached to the body, one affects the other, and the person must be considered as a whole.
Did you know that people with schizophrenia die, on average, around 20 years sooner than a matched population without schizophrenia? Cardiovascular disease, diabetes, smoking, poor diet and little exercise are involved, as are medicines whose side effects contribute to poor motivation, and metabolic syndrome. Physical health management and improvement is bread and butter to lots of pharmacists.
People often stop taking antidepressants before they get a chance to see any benefit. Pharmacists can provide support, encouragement and education on what to expect with treatments.
Lithium is an obvious high risk medicine we can focus on, it has numerous interactions and narrow therapeutic index – support, monitoring, education are obvious roles for us.
There are many roles for pharmacists, from formulary management issues to prescribing clinics for antidepressant reviews, sleep and hypnotic management and benzodiazepine withdrawal, from weight management to smoking cessation, cardiovascular risk factor monitoring and management, education, support and signposting.
It starts with awareness of the issues and knowing who to ask. There are specialist pharmacists in mental health services across the UK. We are too few to do everything ourselves but are delighted to help our colleagues work with people who have mental health problems to achieve their best possible mental and physical health.
For advice on how to support patients with mental health issues, take a look at our Mental Health Toolkit.