By Mike Boivin BSc.Phm.
Clinical pharmacist and lecturer Jamie Kellar is a mental health champion and a huge believer in the power of pharmacists to make a difference.
“Pharmacists are ideally positioned to help address many of the key concerns of individuals with mental illness,” she says. One in five Canadians live with a mental illness – which is greater than the number of people with heart disease and type 2 diabetes combined.
Jamie Kellar has devoted much of her professional life to managing individuals with mental illness, as a clinical pharmacist in tertiary mental health facilities, in community pharmacy practice, and as an educator at the University of Toronto.
“Although pharmacists may not feel confident in managing this patient population, there are many simple changes they can make tomorrow to improve the care and reduce the stigmatization of individuals living with mental illness,” she says.
1. Know the indication for all medications.
“Most individuals with mental illness are pleased to engage in conversation with their pharmacist and will openly share information about their condition and their medication experiences. The amount of information shared is likely to increase if the discussion occurs in a private counselling area. Details of the mental illness are crucial, as many medications can be used for many conditions and/or used off-label.”
2. Address medication adherence and follow-up.
“Adherence to medications used to treat mental illness is often partial or incomplete, which is not unlike what is seen with other chronic diseases. Many psychotropic medications take several weeks to be effective, and are often associated with troublesome adverse effects. For example, a patient starting an antidepressant may experience adverse effects within the first few days of treatment, with no observed change in mood. This may lead some individuals to stopping their medication early. A quick call by the pharmacist, after the first or second week of treatment is an excellent opportunity to address these concerns and improve adherence.”
3. Become familiar with community support.
“Pharmacists don’t have to feel that they are required to provide all the care and counselling to a patient with mental illness. By having a list of services available in the community, pharmacists can help patients tremendously by referring them or their families to other support services.” A great starting point is the nearest branch of the Canadian Mental Health Association (www.cmha.ca).
4. Connect with the prescribers of psychotropic medications.
“Building a relationship with prescribers can ensure patients are given consistent information regarding their illness and their medications. I would recommend starting with prescribers who treat a large number of patients with depression, because it affects a significant number of Canadians and is managed by primary care providers.”
5. Ask patients if they use other pharmacies and perform regular medication reviews.
Many individuals may use multiple pharmacies for their medications. “Several patients at my hospital receive medications from us due to coverage issues. Our pharmacy team works hard to encourage patients to get all of their medications in one place, however this is not always possible. Many times there is no comprehensive list of medications that the patient is taking from all prescribers. This is a significant opportunity for pharmacists to work with patients to create best possible medication histories that can be shared with all clinicians involved in their care.”