Pharmacists are central to supporting mental health care

by Emily Laing

After 6 years of the hustle and bustle in London, I decided to return home to the rolling welsh hills for an exciting new role as advanced primary care pharmacist specialising in mental health at Cwm Taff Morgannwg University health board. The welsh healthcare system was new to me, the way primary care functioned was new to me and starting a new service in the middle of a global pandemic was most certainly new to me.

During my time as a resident pharmacist at Guys and St Thomas’s NHS trust, I undertook a placement at South London and Maudsley NHS trust, where my world was opened up to mental health as a speciality. I really enjoyed the unpredictability of each day, the passion of my colleagues, as well as the new responsibility given to me to provide evidence-based treatment options. Soon after, I made the switch from general hospital to mental health, initially covering inpatient wards but then moving over to the community mental health teams.  During these years, I have been lucky enough to be supported to complete a clinical diploma, independent prescribing course and most recently an MSc in pharmacy research.

There are still so many unknowns with mental health. Guidelines for some conditions can often seem vague and a trial and error mentality when it comes to treatment. This means that pharmacists as experts in medicines have an essential role in mental health treatments.

Adherence to medicines is the main reason for re-admissions to hospital. This is another key role for mental health pharmacists to provide timely medication information, involve patients in their treatment choices and help to match medication regimens to a patient’s lifestyle and beliefs with the hope of supporting better adherence.

When you are dealing with a person suffering from an episode of mental health deterioration, you are dealing with someone at their most vulnerable. It is extremely rewarding to know that pharmacists, as experts in medicines, can use their skills and experience to support people to feel better and to be able to watch them gradually get back to feeling themselves.

During my roles over the years in secondary care, I realised the disparity of mental health services offered to people in secondary care compared to primary care. The majority of secondary care services are bursting at the seams, which means the vast majority of patients who need help are managed in primary care. GP’s, practice nurses, cluster pharmacists and community pharmacists get minimal training in mental health, yet they are dealing with the majority of the patients. So, when I saw this role in CTM advertised, I thought it was the perfect step.

Since being in post, I have spent most of my time building relationships with GP practices, primary care pharmacists and secondary care mental health services. It has taken time to understand where we are as a health board on different mental health services and where we need to be. I have been busy answering clinical queries, providing staff training, and evaluating progress of valproate in females of child bearing potential. I was also working on the discontinuation of Priadel but I am so grateful for the RPS campaign which has helped to ensure patient access to this vital medicine.

All of this has been done in a time of uncertainty due to the pandemic. There have been many challenges along the way and I expect more over the coming year but I feel each day I am progressing (slowly). Although there are challenges, the excitement and determination to develop this service to support primary care practitioners to provide better care for patients outdo the challenges. I feel very grateful to have the opportunity to shape primary care mental health services across the health board at a time when it is needed the most.