By Nicola Greenhalgh, Deputy Chief Pharmacist Essex Partnership University NHS Foundation Trust
Integrating mental health in medication support
The New Medicines Service (NMS) aims to support patients to take medicines as they are prescribed, support adherence, and seek early support with issues. Patients with serious long-term mental health conditions are frequently prescribed new medicines, but not one of the 16 areas the NMS covers are mental health conditions.
The good news is, in 2021 the College of Mental Health Pharmacy was approached to provide clinical support into the development of the antidepressant arm of the service - and I am a member of the working group. Whilst it’s not clear why there were such long delays in bringing antidepressants on board, when they were added we wanted to make sure it supported patients and pharmacists properly and wasn’t just a token addition.
Building pharmacists’ confidence
It became clear that to ensure that the protocols for community pharmacists were flexible and able to follow up with patients appropriately, the service specification needed to be adjusted. One of the main concerns around the introduction of the NMS for antidepressants was that pharmacists lacked confidence when consulting with patients about depression. The biggest fear was that a patient might open up around feelings of self-harm and suicide, so we needed to ensure that pharmacy staff could support the patient, but also recognise this can be difficult for staff.
Recent studies have shown pharmacists don’t feel confident dealing with mental health patients, and that they have no more knowledge than the general public [1-2], so there is a lot more we can do to help.
The introduction of the NMS has been hesitant, and whilst the working group has done a lot to build confidence, more needs to be done. We have to ensure pharmacists are just as confident talking to patients about antidepressants as about antihypertensives or anticoagulants.
Antidepressants attract controversy
Pharmacists’ confidence hasn’t been helped by the explosion in antidepressant prescribing, controversy surrounding their efficacy, and growing evidence around withdrawal. What it has done is shown the need for pharmacists to be able to support new patients taking antidepressants. Particularly since the pandemic, patients have had questions about the appropriateness of their treatment and concerns about their effects in the longer term. Their questions have shown pharmacy staff need to improve their knowledge in this area.
These gaps shouldn’t prevent us from having much needed conversations, instead, they ought to push us to develop more robust training and education around mental health. Hopefully, as the NMS for antidepressants develops, we can build upon existing resources and bridge the gaps. Then, once these conversations become part of everyday practice, we can begin to address more mental health conditions.
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References
[1] Gorton H, Macfarlane H, Edwards R et al; UK and Ireland survey of MPharm student and staff experiences of mental health first aid. J Pharm Policy Pract 2021; 14:73
[2] Gorton H, Strawbridge J, Macfarlane H; Mental Health: “It is a subject where most pharmacists (or pharmacy) students have no more knowledge than the general public. J Pharm Policy Pract 2023; 16:13