Pharmacist Counseling with Mental Health Patients

August/September 2014, Vol 2, No 4 - Inside Mental Health
Shelby Free, PharmDc

Mental illness has become a significant problem in public health, with almost 25% of the US adult population with a mental disorder.1

The rates of medication adherence in this population have always been a significant challenge for healthcare providers.1 Rates of nonadherence in particular mental disorders, including bipolar disorder and depression, often exceed 50% and contribute to the poor health outcomes and increased healthcare costs associated with these diseases.2

Making an Impact on Adherence
Pharmacists can have an impact on patient adherence in any disease state by providing education through consultation with their patients.

However, a survey developed by the College of Psychiatric and Neurologic Pharmacists Foundation and the National Alliance on Mental Illness in 2012 found that 75% of respondents reported they did not receive effectiveness or safety monitoring assistance from their pharmacists; 43% of the respondents taking mental health medications stated they did not have a strong relationship with their pharmacist.3 The reason for these numbers may be largely due to the numerous barriers associated with educating this population. The primary concern reported in the study was the lack of privacy in the pharmacy to perform these consultations.3

Other barriers to counseling include the inability of pharmacists to communicate because of lack of time, lack of patient-specific information, and inadequate training, as well as patients with complex dosing schedules, drug interactions, and cultural influences.2,4 As a pharmacist, it is important to conquer these barriers by implementing strategies to address these concerns, such as lack of privacy, which can be overcome by designating a private area in the pharmacy for consultation, or scheduling telephone consultations at times convenient for the patient.3 For complex dosing schedules or patients taking multiple medications, a pillbox or a blister pack could be very beneficial.2 Under the appropriate conditions, pharmacists do have the opportunity to play a positive role in the mental health field.

Patient Education Is Key
The importance of counseling patients cannot be stressed enough, especially in a population that uses mental health medications. The side effects and strict regimens associated with these medications can often deter patients from their use. However, it is our job as pharmacists to inform these patients of what to expect while taking these medications.

One important counseling point regarding mental health medications includes their delayed onset of action. Many of these medications, including antidepressants, require at least 2 weeks before any antidepressant activity is noted. It is important to inform patients that they should not expect to feel better right away and that they need to give time for the medication to take effect.5 Failure to notify patients of this fact can often lead to early discontinuation of their medications because they do not believe the medicine is working appropriately.

Side effects associated with medications can have a significant impact on patient adherence, and should also be explained during patient consultation. Patients should be informed of what to expect when taking a medication and the importance of following the entire prescribed regimen. Often, patients begin to feel better and decide that the medication is no longer needed to help them. What they may not comprehend is that this is a result of their medication, and that by stopping the medication prematurely, they will revert back to their usual behavior. This is why it is extremely important that patients are informed to continue taking the medication even if they do start to feel better.5 The abrupt discontinuation of certain medications that require dose tapering could also have a negative impact on patients. Patients should also be aware that stopping these medications “cold turkey” could produce unwanted side effects.6 Our goal as pharmacists is to improve patient health and quality of life, so counseling patients on these important side effects is an example of how we can achieve that goal.

Third-Party Consultations
If the patient is not directly available for counseling, it is still important to make sure that the counseling points are discussed.

Third parties can play an important role in taking care of the patient; therefore, it is equally important to inform them of any pertinent drug information. Although the Health Insurance Portability and Accountability Act prevents a pharmacist from discussing personal information with these third parties,7 it is still appropriate to discuss important points about the medication. Informing third parties of how medication should be taken (eg, daily, multiple times per day, with or without food), along with the notable side effects associated with the medication, are impor­tant for the patients’ overall health.

Third parties should be informed of the appropriate situations in which a physician should be called and should encourage them to have the patient call you if any additional questions arise.

Taking a Step Forward in Mental Health Care
To show the impact pharmacists can have on antipsychotic medication adherence, a controlled trial involving patients with schizophrenia, schizoaffective disorder, and bipolar disorder was conducted.2 Using pharmacist-based intervention versus no pharmacist involvement, the study found that during a 12-month period, adherence rates had a statistically significant improvement from a medication possession ratio of 0.54 at baseline to 0.86 in the pharmacist-controlled group compared with no pharmacist involvement.2 This study helps to show that pharmacists can make a difference with medication adherence by becoming actively involved with their patients’ overall care.

More than ever, the impact that pharmacists have on a patient’s medication-related outcomes is extremely important. Counseling patients on appropriate side effects and additional medication-specific information plays an important role in improving adherence. As pharmacists, it is our duty to take a step forward and overcome certain barriers and ensure our patients are receiving the best healthcare that we can provide. We are given the opportunity to have a positive impact on our patients’ lives, and it is up to us to make sure that we are doing so every chance we get.

References

  1. Centers for Disease Control and Prevention. CDC Report: Mental Illness Surveillance Among Adults in the United States. www.cdc.gov/mentalhealthsurveillance/fact_sheet.html. Accessed June 27, 2014.
  2. American Pharmacists Association. Improving medication adherence in patients with severe mental illness. Pharmacy Today. 2013;19:69-80.
  3. Tanzi MG. Improve counseling of patients with mental health conditions. American Pharmacists Association. www.pharmacist.com/improve-counseling-patients-mental-health-conditions. Accessed June 27, 2014.
  4. Bostwick JR, Diez HL. Optimizing care for patients with depression in the community pharmacy setting. US Pharm. 2008;33:24-28.
  5. Teter CJ. Counseling patients being treated with antidepressants. 2004. www.pharmacytimes.com/publications/issue/2004/2004-02/2004-02-7660. Accessed June 27, 2014.
  6. National Institute of Mental Health. Mental Health Medications.
  7. www.nimh.nih.gov/health/publications/mental-health-medications/index.shtml. Accessed June 27, 2014.
  8. Figge HL. HIPAA: privacy, security, and pharmacy information technology. US Pharm. 2011;36:79-81.
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