MENTAL HEALTH


‘All patients receiving new medication are offered a one-to-one private consultation to advise them on how best to use their medication and also discuss any other questions and issues. We advise on key lifestyle factors such as good sleep hygiene, and for patients who are students, we can signpost to various academic support services. We arrange both telephone and face to face follow- ups and once patients are settled on repeat medication, we check how they are progressing with their treatment. For patients we think are at risk of harming themselves, we liaise with our GP colleagues, ensuring they get timely appointments and the regular contact and support they need.’


At the other end of the age spectrum, RPS’s Practice and Policy Lead in Scotland, Aileen Bryson, points to the need for continuing pharmaceutical care of the elderly:


‘There’s a huge amount to be done to reduce the antipsychotic medicines being prescribed to older people, which is one of the reasons that we are calling for pharmacists to have more input into care homes so that we can be sure people are only kept on these drugs for the duration of an episode that warrants them, and not left on them, because they have such a big impact on the risk of heart attack and stroke.


‘There you have a pharmacist working with a GP practice, this too is an ideal opportunity to provide holistic medication reviews. For instance, where somebody is looking for a further supply of antidepressants, which were deliberately not on repeat prescription so that they could be monitored, a pharmacist could do a review and make the judgement in terms of how severely ill the person is, perhaps based on a set of agreed sensible questions to spot any red flags.’


While there are fewer independent prescribers active in mental health compared with physical health, Maree Todd suggests some pharmacists in acute settings are leading the way:


‘My colleagues in the hospital department I worked in in Inverness are all prescribers now and are taking their specialist skills out into the community, working with psychiatrists, GPs and community mental health teams. It’s quite an


innovative pilot and early results are promising. If successful, they will relieve some of the pressure in primary care and provide the continuity which is so essential in mental health care. They are keen to link in with primary care clinical pharmacists and community pharmacists too. One of the areas they are making a big difference in is the physical health of folk with mental ill health.’


So, what are the things that are needed to allow pharmacists to achieve more of their potential in supporting people with mental illness?


For Minister for Mental Health, Maureen Watt MSP it is training.


‘The Mental Health Strategy outlines opportunities to provide training in first aid approaches for mental health as well as peer support, digital tools and better use of electronic information which all have the potential for widening access, supporting co-production and self- management. There is potential for pharmacists to undertake mental health first aid training as well as use appropriate technology tools and information to support shared decision making and help people to self-manage their condition.’


Achieving the Mental Health Strategy’s ambition of ‘ask once, get help fast’ will require the professional who is ‘asked’ to be able to trigger the process of delivering help. And, given that pharmacists are often the first port of call, Adam Osprey of Community Pharmacy Scotland wants to see more structured, digitally-supported referral systems:


‘If somebody presents who is in need of a physiotherapist, for instance, then it varies depending on the NHS board as to how you go about referring into that service,’ he told SP. ‘Whether it is dietitians, nutritionists or mental health support workers, there are informal local ways of getting people into the services, but they vary.


‘Sometimes it does just feel like a referral rather than a full clinical handover to a fellow professional. Often, we don’t know what happens to a person who we have referred. We don’t even know if they have necessarily gone ahead and accessed the care that we arranged and whether the appointment has been met.’


‘THERE HAS TO BE THAT FOLLOW-UP, THERE NEEDS TO BE THAT FOLLOW-THROUGH. THE INFORMATION HAS TO FOLLOW PEOPLE AS THEY MOVE ACROSS SECTORS BECAUSE TOO OFTEN WE SEE PEOPLE FALLING BETWEEN TWO STOOLS.’


Community Pharmacy Scotland adds that the need for community pharmacists to have role-based access to clinical records is as great for people with mental health problems as for every other person who seeks their help.


Aileen Bryson says consistent communication within pharmacy is also important.


‘There has to be that follow-up, there needs to be that follow- through. The information has to follow people as they move across sectors because too often we see people falling between two stools.’


Maree Todd wonders whether the development of the role of pharmacy in supporting people with mental illness is being matched by the medicines available to treat the patients affected.


‘In the 20 years I worked in psychiatry, the main progress I feel we made was learning to use the drugs we had more effectively. I have reflected a lot on the lack of new drugs and progress in treating illnesses like schizophrenia and bipolar affective disorder – we don’t even really understand the underlying pathology.


‘When you compare that to some of the great strides made in cancer treatment it’s disappointing. These illnesses are common - both affecting around one in 100 people worldwide - and can have a huge impact on the person’s life. From a purely economic perspective, you’d think all the world’s best brains would be trying to understand them.’


Interestingly, the medicines makers agree. The Head of Regulatory and Safety Policy at the trade body for the research-based medicines industry, ABPI, is Sunayana Shah.


‘Research into mental health and the broader aspect of neurology is a complex area that needs co-operation between industry, academia, clinicians and patients to translate cutting-edge science into treatments that will be useful for patients,’ she told SP. ‘While our understanding in many therapy areas is expanding very quickly, the rate of change in neurology is slower because the basic science around some conditions is still emerging. Companies do continue to research new treatments, with promising developments for early or mild Alzheimer’s disease in the pipeline for example, but we know that we have a very long road ahead.’ •


SCOTTISH PHARMACIST - 25


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