Expanding the Pharmacist’s Role in Mental Health Care

SHARELINES

The recent tragedy in Newtown, Conn. has increased awareness about the need for greater support for individuals with mental health issues in today’s health care system.

While doctors, nurses, and therapists have always been considered among the health care professionals working closely with the mentally ill, some believe community pharmacists should also be a member of the health care team.

Charles Caley, a clinical professor of Pharmacy Practice, specializes in pharmacotherapeutics for psychiatric illnesses. (Photo courtesy School of Pharmacy)
Charles Caley, a clinical professor of pharmacy practice, specializes in pharmacotherapeutics for psychiatric illnesses. (Photo courtesy of the School of Pharmacy)

But if community pharmacists are going to be more involved in helping the mentally ill manage their medications and adhere to their prescribed dosages, they must do more to improve their relationship with the individuals they treat and they must create environments where patients’ privacy is both respected and protected, says Charles F. Caley, a clinical professor of pharmacy practice in UConn’s School of Pharmacy. Caley co-authored a report that looked into the relationships between people with mental health conditions and their community pharmacists.

According to the report, approximately 75 percent of individuals with mental illness and caregivers who responded to a recent national survey said they seldom or never receive assistance from their pharmacist regarding the safety or effectiveness of their medication even though the great majority of those individuals felt comfortable and respected visiting their local pharmacy.

The respondents cited lack of privacy as their primary concern for not discussing their medications with their pharmacist.

Understanding the Consumer

The online survey was conducted in the fall of 2012 in collaboration with the National Alliance on Mental Illness (NAMI) and the College of Psychiatric and Neurologic Pharmacists Foundation (CPNPF), of which Caley is president. While previous surveys have looked at helping the mentally ill from the pharmacist’s perspective, the NAMI-CPNPF studied focused on the point of view of the consumer.

Caley analyzed the survey data and co-authored the final report with Professor Glen F. Stimmel of the University of Southern California. More than 1,000 people participated in the survey, which was exclusively promoted by NAMI through various websites and email. NAMI is the nation’s largest grassroots mental health organization dedicated to helping people affected by mental illness. The number of individuals with mental illness who responded to the survey compared to caregivers was about two to one.

Caley says the findings provide an opportunity for community pharmacists to explore creative ways to help individuals with mental health conditions manage their medications and identify potential issues.

Nationally, more than 118,000 pharmacists work in community settings, representing 43 percent of the profession overall. Caley believes community pharmacists can and should be an important resource for any mental health care team.

“We believe that a strong relationship between community pharmacists and individuals with mental health conditions is both desirable and advantageous,” says Caley, who is one of about 2,000 “psychiatric pharmacists” specializing in mental health medications in the U.S. “But if pharmacists want to be more active member of the health care team, we need to be more accessible and we need to find out ways to eliminate the barriers that currently exist.”

One way pharmacists can help, Caley says, is by making sure patients adhere to their Pharmacy Pill Bottledoctor’s prescriptions and treatment program by tracking refill rates. They can also identify possible adverse interactions with other medications and help reinforce in patients the importance of continuing medication therapy despite feeling better, Caley says. Many pharmacists already do that for patients with diabetes, high blood pressure, and other conditions, he says.

“Every community pharmacist has an opportunity to talk to their patients and be part of their support network,” Caley says. “But we have relied on an individual pharmacist’s empathy and altruism to reach out and be proactive. What we have to do is a better job of convincing community pharmacists that they need to invest their time in doing these things.”

But Caley admits getting pharmacists more involved is difficult because of the barriers that currently exist.

“Pharmacists are the only health care professionals who exist in a retail environment,” Caley says. “So retail rules apply and often they are not conducive to private discussions.”  Competing work responsibilities, lack of knowledge about managing different mental health conditions, and the potential need for advanced training have also been cited by pharmacists as barriers preventing them from working more closely with patients with mental illness.

Symposium Addresses Effect of Sandy Hook on Mental Health Care

Recognizing the relevance and importance of this issue, the UConn School of Pharmacy this year chose to look at the intersection of pharmacy practice and mental health as the subject of its 36th Annual Arthur E. Schwarting Symposium. On Thursday, May 30, more than 80 pharmacists from across New England, New York and New Jersey will take part in a day-long symposium at UConn entitled “What Has The Sandy Hook Tragedy Prompted Us To Do About Our Mental Health System?”

“We thought we could get professionals together to discuss access, monitoring, and adherence to treatment plans for patients with mental health issues and inform the medical community about resources they have to assist these patients,” says Jill Fitzgerald, one of the event’s organizers and UConn’s director of pharmacy professional development.

“Pharmacists come in contact with patients on a monthly basis for refills of medications and are one of the most accessible health care providers,” Fitzgerald says. “They also are often answering questions from parents and caregivers of patients routinely.  They generally have information about adherence to medications and can assist patients in minimizing side effects and improving their disease.”

As part of the symposium, guests will hear a report from a member of the CT Mental Health Subcommittee of the Sandy Hook Task Force; learn more about potential adverse psychiatric drug interactions, and discuss ways pharmacists and other health care providers can better assist individuals living with mental illness.

With the survey results in hand, Caley said he and Stimmel intend to work with the American Pharmacists Association Foundation and other groups to develop programs that will help community pharmacists become more comfortable monitoring and managing medications for individuals with mental health issues. At the same time, the pair is working with NAMI in helping educate individuals with mental health conditions about ways they can improve their relationship with their community pharmacist, ask questions and seek help if they need it.

“The survey suggests areas for action to strengthen the role of community pharmacists as part of treatment teams for mental health problems as well as other medical conditions,” said NAMI Executive Director Michael J. Fitzpatrick. “Pharmacists can serve as a first line of defense in identifying medication issues to be discussed with a person’s doctor – before any concern turns into an adverse event.”