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Pharmacists as mental heath professionals?

Croakey has been asking some tough questions about the pharmacy profession in recent posts (here and here, in case you missed them).

Not surprisingly, some in the profession may have felt a little miffed that the critique didn’t acknowledge that good work is being done.

Thanks to Dr Simon Bell, a pharmacist with connections to the University of Kuopio in Finland and the University of Sydney, for providing this report of a recent project in Sydney aiming to improve quality of medicine use for people with mental illness.

He writes:

“Medicines are among the most common treatments for mental illness. However, people with mental illness often report their dissatisfaction with information about medicines. In addition to providing benefit, many of the medicines used to treatment mental illness can cause adverse drug reactions.

In an initiative conducted by researchers from The University of Sydney, trained pharmacists conducted interviews (30–45 minutes each) with clients of community mental health teams.

The purpose of the pharmacists’ interviews was to identify actual and potential problems that clients may be experiencing with their medicines.

The pharmacists then participated in team discussions with members of the community mental health teams and made recommendations about possible strategies to optimise medicines use.

The initiative was evaluated by a 4-member expert panel comprising a psychiatrist, general practitioner, specialist psychiatric pharmacist and a medicines review pharmacist.

Overall the panel believed that participation of the pharmacist had a positive clinical impact for 77% of clients who received the service. The model was also well received by the community mental health team staff (reference available here, pay to see article).

The initiative demonstrated a model whereby appropriately trained pharmacists can contribute to improving the use of medicines.”

It seems to Croakey, however, that this study raises at least as many questions as it answers:

• If the treatment of mental illness could be improved by community mental health teams working more closely with pharmacists, then how widely is this happening?

• If it’s not widespread (as I suspect), then why not? What are the barriers, and how might current models of practice need to be changed to enable such collaboration?

• Is there anything that individual patients and their families, carers and clinicians can do to obtain this type of service?

If Croakey readers have any constructive thoughts on these issues, please let me know. I’m happy to put up more posts on this issue.

Comments 5

  1. Doctor Whom says:

    As I read it the paper suggests that the the panelists agreed with each other and also agreed this was “likely” to result in improved outcomes. Not that the recommendations were implemented or that they DID produce improved outcomes.

    Perhaps I’m missing something?

    I can think of shiploads of my ideas that I reckon would result in improved outcomes – if only people did what I said. Unfortunately they either don’t listen or don’t agree with me.

    This wouldn’t be academic pharmacists trying to carve out increased territory for pharmacists would it?

  2. Croakey says:

    Dr Whom, who would have guessed you were so cynical! Given the resistance within sections of the medical profession to pharmacists (or indeed any other health professions) extending their role, it seems fair enough that a first step in a project like this might be to show medical support for the pharmacists’ intervention.

  3. Doctor Whom says:

    Dear Ms Croakey
    Other than the predictable bleatings by the AMA I’d say medicos are far less resistant than most other health professionals about encroachment on turf or obsession with strict demarcation in job descriptions. Remember the rows when it was suggested to nurses that perhaps making beds and serving meals weren’t best performed by them?

    Anyway – back to pharmacists- my criticism was on this study – which as I said appears to me to not be about actual interventions but possible interventions. I’m still not clear.

    The greatest thing holding back pharmacists expanded role is the Guild and it’s anti-competitive practices and cosy arrangements with government. The restriction on pharmacies is particularly galling when prices for fairly common PBS items can vary from between $30 – $15. (This is last week between the pharmacist near the medical clinic and a Chemmart 5 ks away.)

    And even more galling when these protected pharmacists are mainly selling expensive cosmetics, quack diet and slimming “plans”, Herbal “treatments”, vitamin “cures”, fake suntans and even homeopathy flim flam. I won’t be surprised when I see a pharmacy pushing chiropractic “cures’ for everything or Scientology.

    There is a good case for “Community Pharmacists” in GP clinics and community health centres – as well as community mental health teams. The Home Medicines Review model seems to me to have been a success but severely limited in it’s reach and funding.

  4. Croakey says:

    Dr Whom, I can only agree with the above.

    Re the “predictable bleatings” of the AMA, the trouble is that these tend to dominate the airwaves. Which raises the question of how well the medical profession generally is served by the dominance of the AMA in public debate?

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