MENTAL HEALTH
EARLIER THIS YEAR THE SCOTTISH GOVERNMENT PUBLISHED ITS MUCH-ANTICIPATED NEW MENTAL HEALTH STRATEGY WITH AN AMBITION TO PREVENT AND TREAT MENTAL ILL-HEALTH WITH THE SAME COMMITMENT, PASSION AND DRIVE AS PHYSICAL HEALTH PROBLEMS. PHARMACISTS HAVE ALWAYS BEEN CLOSELY INVOLVED IN THE CARE OF PEOPLE WITH MENTAL ILLNESS BUT, AS JOHN MACGILL HAS BEEN FINDING OUT, THE PROFESSION’S POTENTIAL IS PERHAPS ONLY BEGINNING TO BE SEEN.
ASK ONCE, GET HELP FAST?
n her introduction to the Mental Health Strategy 2017-2027, Scotland’s first Minister for Mental Health, Maureen Watt MSP, sets an ambitious tone:
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‘We want to see a nation where mental healthcare is person-centred and recognises the life-changing benefits of fast, effective treatment. We want a Scotland where we act on the knowledge that failing to recognise, prioritise and treat mental health problems costs not only our economy, but harms individuals and communities.’
‘Our Mental Health Strategy states that we’ll support the development of new multi-disciplinary models of supporting mental health in primary care to ensure that people can ‘ask once, get help fast,’ Maureen Watt told Scottish Pharmacist. ‘Given the role of pharmacists in providing both advice and medicines, there is potential for them to have a role in helping to support this ambition. A wide range of clinical and non-clinical staff, including pharmacists, can provide problem-solving, listening
24 - SCOTTISH PHARMACIST
and signposting for physical, mental and social problems and can work with people to optimise their own physical and mental wellbeing.’
One person with a unique perspective as a Member of the Scottish Parliament with a career in psychiatric pharmacy, is Maree Todd MSP. She believes pharmacists play a vital role in supporting people with mental ill health:
‘Medication can be the cornerstone of treatment for illnesses like schizophrenia and bipolar affective disorder,’ she told SP, ‘but the medicines are not easy to use and it can be hard to find the one that best suits the patient. Even when non-drug treatments are the preferred option, drugs are often still prescribed, like in personality disorders, and a pharmacist’s role can be helping to avoid harm from medication in these conditions.
‘Some mental illnesses are very common and because treatment is needed during childbearing years, specialist advice on drugs in pregnancy and breastfeeding is essential. For
illnesses like depression, where there are non-drug treatment options too, a pharmacist can help weigh up the pros and cons of both options of the individual patient. Those with severe depression will need medication before they will be able to engage with talking therapies. Those with mild depression would be best treated with talking therapies. Pharmacists have a key role to play in choosing the right medicine, minimising and monitoring for side effects, and helping the patient to keep taking the medicine for as long as they need to.’
Maree Todd says it is rewarding to see how good pharmaceutical care makes a real difference to a patient’s quality of life.
‘There were people I met early on in my time at the hospital whose care I was still involved in 20 years later when I left. These are often chronic illnesses so you can’t cure them but you can make a difference. From an intellectual point of view – there probably isn’t a more complex organ system than the brain – a keen pharmacist could spend their whole working life trying to understand it and using that knowledge to improve lives and still have plenty to learn.’
For the majority of people with mental illness, supported outside hospital, community pharmacists have long been central to their care. Indeed,
according to Policy and Development Pharmacist with Community Pharmacy Scotland, Adam Osprey, they may be the health professionals who people on medication see most often:
‘Generally, people will visit the pharmacy every month or even more frequently depending on their medication schedule. Good relationships are built between pharmacists, pharmacy teams and clients. We get to know them very well. It’s a privileged position to be in. People quite often open up to us when things are not going so well and that is where the pharmacist can offer support, and also referrals into other services.
“Even when people do not volunteer the information themselves that things aren’t going so well for them, the pharmacy teams will often pick up changes in a person’s behaviour, their demeanour perhaps, and pick up clues. We have a professional duty to pick these up, to identify the issue and to help people access the care they need.”
In its Care for People with Long Term Conditions policy document published at the end of last year, the Royal Pharmaceutical Society (RPS) in Scotland cited the work being done with students with depression and anxiety by one campus pharmacy team:
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