PJ Online | PJ Letters: Mental health
The Pharmaceutical Journal
From Mrs P. Brown, MRPharmS, and Mrs K. Kinsey, MRPharmS
In response to the letter, "Develop links with psychiatry" (PJ, 9 November, p676), we would like to share the example of a close working relationship that has occurred between primary and secondary care mental health providers in Manchester.
In August 2001 a group of long-term, mentally ill day patients were required to move out to a community setting. A crucial issue to consider was how these clients would manage their medication. We were involved in a project team to develop and involve community pharmacy in Manchester.
Over 45 community pharmacists expressed an interest in the project and 30 were called to attend the Centre for Pharmacy Postgraduate Education course on mental health. The remaining pharmacists were trained six months later. After the initial training the community pharmacists attended a training session that explained how to manage the clients, how to respond and look out for signs of relapse and where to refer problems. The training was attended by a local user group, community mental health team and had input from the North West Psychiatric Pharmacists Group. The community pharmacists were given the task of monitoring eight needs areas around issues such as compliance, over-the-counter purchases, lifestyle advice and explanation of the side effects of medication. Information was shared with the pharmacies regarding care plans, diagnosis, relapse signatures, previous non-compliance, and all contact details necessary to allow concerns to be raised with the appropriate individual. They were also tasked with ordering repeat prescriptions and to respond to any changes in medication communicated from secondary care. The trained pharmacists were given the title of "mental health resource pharmacists".
The work has continued for one year with positive results. We have been able to demonstrate that community pharmacy has a place in managing the most difficult patients with regard to compliance and with clear lines of communication they can feed back information about the patient's well being. One of the primary care trusts has now funded this service.
From Miss W. Ackroyd, MRPharmS
I agree with Martin Nasr and Dr Joseph Guirguis (PJ, 9 November, p676) that it is time that there were stronger links between community pharmacists and community mental health teams. Merely acknowledging this does not give any indication of how to proceed or why links are not there in the first place. As a hospital pharmacist working in psychiatry I have been dismayed by the lack of interest or enthusiasm in mental health issues in my community colleagues. Taking a step back gave me a clue why.
In my days as a community pharmacist I would not have thought my undergraduate training would prepare me for offering my services to a community mental health team. Neither would completing the Centre for Pharmacy Postgraduate Education pack on mental health, as interesting as it was, have encouraged me to participate in the way that perhaps a similar pack on hypertension or diabetes might have. Hypertension and diabetes are nicely measurable, I could clearly see where I might have an input and having read the various guidelines I could feel confident that I might make a measurable difference for which, perhaps, I could clearly identify a "fee" (after all I am in business).
As a community pharmacist I was nervous about this huge area of mental health which I believed I knew little about. Perhaps I did not know whom I could contact for support, or to refer to if I came across something I could not answer. Luckily I know now that there are enthusiastic people working in pharmacy in psychiatry who are happy to direct their community colleagues to the people they need to talk to, and advise on the kind of things they could do to improve links between community pharmacy and mental health services and people with mental health problems. There is also the UK Psychiatric Pharmacy Group, an organisation that pharmacists can join if they are working in any area with an interest in mental health. It can provide access to training, support and the experience of 400 or so other pharmacists (www.ukppg.org.uk).
Perhaps the missing link is really that between the secondary care specialists and the community pharmacists.
We are often more willing to take a step into the unknown if we know there is support available.
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Citation: The Pharmaceutical Journal URI: 20008260
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