MENTAL HEALTH


‘It is important to have an understanding of the challenges and experiences faced by people with schizophrenia in their daily lives. The research evidence shows that stigma, physical health, experience of services and quality of life may be as important to recovery from psychosis as access to treatment and services.’


Frances Simpson, Chief Executive of Support in Mind Scotland, believes that greater understanding of the particular challenges faced by the patient with schizophrenia will enhance the role that the community pharmacist can play.


‘The community pharmacist could have a really positive role for patients with schizophrenia,’ Frances told SP, ‘not only in assisting the patients themselves, but also in offering support and advice to their families and carers, who often don’t get to speak to healthcare professionals.


‘I think it is interesting to note that, in preparing for this feature, I sent an email an email to a variety of people, including our members, professionals who advise us as an organisation, and other healthcare professionals. I received an overwhelming response: a response, which I feel clearly indicates how central a role many of the professionals felt that the community pharmacist could play.


MONITORING


‘One of the main ways in which I feel that the community pharmacist could play a major role is in terms of monitoring. By this I don’t just mean in terms of monitoring of medication and compliance – although that is also vital – but in terms of recognising changes in the patient’s demeanour or behaviour. In schizophrenia, there are times when a patient may not be coping as well as usual and this will manifest itself in symptoms such as their appearance becoming disordered, or they may appear withdrawn. Some patients may start to behave ‘strangely’ and say odd things. Such actions will only be picked up if the pharmacist – and their team – has a good relationship with the patient.


‘This type of relationship tends to happen more easily in rural or close- knit communities and there’s no doubt that that level of professional support is invaluable. Chronic Medication Service in Scotland has been particularly successful in enabling


38 - SCOTTISH PHARMACIST


pharmacists to become more proactive in providing one-to-one consultations, which have allowed patients to feel more relaxed about talking.


MEDICATION


‘Naturally, as the medicines expert, the pharmacist is uniquely placed to monitor not only the mental health medication, but also to ensure that there are no contra-indications between the different medications that someone may be taking.


‘With anti-paranoia medication, it’s vital that the patient doesn’t stop taking their medication and so the pharmacist is a means of providing feedback to the GP. If the pharmacist picks up on the fact that a patient may need a bit of extra care, or may need referred for help, they’re ideally placed to convey this to the GP.


‘The pharmacist also has a role to play in providing advice and information to the patient’s family and carers, who often don’t have access to the GP as a result of the confidentiality aspect. The family and carers need to know what to expect in terms of both the patient’s behaviour and of their medication.


‘One area in which we have encountered problems is in the dispensing of generics. While we do appreciate the need for healthcare professionals to prescribe and dispense cheaper alternatives to some of the more expensive branded medicines, in people with paranoia this can be damaging, since a change in the look of the pills, or in the packaging or name, can make people suspicious, scared and reluctant to take the drugs. As I said previously, with this type of medication, it’s vital that the patient doesn’t stop taking medication for any reason.


NON-COMPLIANCE/ NON-ADHERENCE


‘The pharmacist is instrumental in explaining the side effects of anti- psychotic medication - not just the physical symptoms, such as weight gain - but also the emotional ones. By giving the patient some time to speak to them about the medication and to answer questions will provide reassurance for many patients.


‘One point that is difficult to overcome is unique to this illness. Many people with schizophrenia don’t believe they are ill and may be resistant to taking


medication. If this is the case, then they can become argumentative. In this instance, the pharmacist can play a vital role in discussing the situation with the patient and making them feel comfortable and ‘safe’ in taking the medication.


STIGMA


‘In any type of mental health issue, stigma is a huge problem and the side effects of some of the medications can, unfortunately add to this. Such stigma is unique to anti-psychotic medication and pharmacists need to be aware of this and perhaps think about how their expertise could contribute to the debate about stigma and recovery.


‘Pharmacists could, for example,


recognise the need for a private consultation room when dealing with a patient with schizophrenia. Many patients don’t feel comfortable standing at a public counter and speaking publicly about both their medication and their personal details, such as address or telephone number.


‘Overall, we have no doubt that, in light of Prescription for Excellence and the emphasis on the community pharmacist as the most readily accessible healthcare professional on a daily basis, the role of the community pharmacist in the treatment and support of patients with schizophrenia can only be enhanced in the near future.’ •


PATIENT’S PERSPECTIVE


For pharmacists to understand exactly how a patient with schizophrenia feels about their medication there can be no better explanation than that of Graham Morgan MBE, who is a Special Advisor to Highland Users Group (HUG) (Action for Mental Health). Graham has a diagnosis of paranoid schizophrenia and has spent the last six years on a community treatment order. He has been receiving treatment for schizophrenia for about 25 years.


‘So why do I hate drugs?


‘I would like to say I hate drugs because, they dull me; they make my life hard to live. I would like to say it, because when I was taking the injections of depixol, I always had to walk in circles, to pace the kitchen with that internal restlessness, or because, when I was on olanzapine I put on weight and felt that little bit subdued or maybe, when I take resperidol, I am conscious that it had an effect on my sex drive, that I seemed to develop man boobs, that maybe the fact that I am on the verge of being diabetic is not just a result of lifestyle but a consequence of the medication.


‘Maybe when I take things like diazepam or lorazapam, I feel that temptation to always be in that warm slurry of softness where my feet and legs stop shivering and I cease to worry.


‘I have asked our members why they don’t like medication and some of their views do chime with mine. I don’t like to feel controlled, I don’t like being told what to do, I don’t like, above all, to be seen as defective and needing mended. I don’t like the implication that if I take medication, I have to admit that there is something wrong with me.


‘I hate the thought that by taking medication I agree I have an illness. I hate the thought that if I take medication I don’t know who I am, that I am masking the real me with the drugs that make me different and acceptable.


‘I hate the fact that by accepting my medication that I accept that your view is the right one and mine a petty delusion. I hate the fact that you are right and I am wrong. I hate that now I have seen my notes and the research into my notes that I have to agree I have schizophrenia when I still know this is a mistake, that if ever there is a test for it, when I am tested they will say; ‘Why no! That is not what he had!’


‘And I hate the fact that I am anxious about what they might decide I am instead. In large part though, I hate medication because I am expected to hate medication.’


For more information visit www.supportinmindscotland.org.uK


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