By Dr. David Gardner, Associate Professor
College of Pharmacy, Dalhousie University
In Canada, one in every five people will live with a diagnosable mental illness at some point in their life. The most common reason adults see family doctors relates to problems with mental health. Medications for treating mental illnesses are the second most commonly used class of drugs following those for heart and circulation problems. Although I have been a pharmacist working in the area of mental health for over 15 years, I am still surprised by these statistics. Unfortunately, we as a society separate mind from body. Although this is a false division, it is one that is well ingrained and has had terrible consequences. People with mental illnesses have been, and often continue to be, treated as second-class citizens, receiving less of our empathy, care, energy, and enterprise. For example, the ruling perception is that having asthma is nothing to be ashamed of but to be incapacitated by obsessive-compulsive disorder (OCD) is a problem to be concealed. Only recently has the teaching changed in health care professional faculties towards a more holistic approach to managing patients’ needs.
Each year, I am responsible for teaching pharmacy students about medications for mental health. In the classroom setting, we focus on many categories of psychotropics including antidepressants, antipsychotics, mood stabilizers, and benzodiazepines in the context of treating illnesses such as depression, schizophrenia, bipolar disorder, anxiety disorders, and others. As with all medications, it is important that our future pharmacists learn about benefits, side effects, precautions, drug interactions, appropriate dosing, and so on. However, knowing the facts about these medications is only the beginning. What I consider to be more important is how the students use this information in helping people reach their mental health goals. Does the student invite dialogue? Does she listen well and respond appropriately to the issues and concerns? Does he demonstrate kindness and enthusiasm?
The relationship between a pharmacist and a person taking psychotropic medications can influence and inform that person’s view of the medications and can also profoundly affect how they view themselves. A woman with schizophrenia and a history of suicide attempts described her relationship with her pharmacist to me as, “Wonderful. He always makes me smile and always goes the extra mile for me.” She never felt judged by her pharmacist or treated differently than any other patient. “I always feel good about myself after seeing my pharmacist. I know he really cares.” Initially, she had difficulty achieving a full recovery, but through working with both her physician and pharmacist, she was able to find the right combination of medications that helped her get her life back.
So what is the role of the pharmacist when working with people with mental illnesses? The answer is the same whether the person has a mental illness, a heart problem, or a stomach problem, whether they are hearing or visually impaired, or if they are young or old. For each and every person, a pharmacist is a clinician, educator, information resource, and supplier of quality medications. A very important role of the pharmacist relates to educating people about their medications. In my experience, most patients have concerns before starting a medication for a mental health problem. I have found that this is related to not fully understanding the benefits and side effects of a medication. Often these worries stem from reports in the media or the Internet, or come from family and friends. Proper information about such medications frequently helps to resolve initial concerns. To make informed decisions about which treatment to take, if any at all, a person needs balanced information from a reliable source. Pharmacists provide this service. They are skilled at accessing, assessing, and communicating information about medications in order to provide individuals with a realistic description of their medication’s benefits and risks.
People who are prescribed medications for mental illnesses are encouraged to meet with their pharmacist to learn more about their medications. Building a relationship with their pharmacist provides them with an ally who will respond to questions and monitor the course of therapy to ensure that the benefits of treatment are achieved. The pharmacist is a uniquely accessible and qualified resource to help meet the medication-related needs of people with mental illnesses.
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