Attitudes of Pharmacists Toward Mental Illness and Providing Pharmaceutical Care to the Mentally III

Role of the Pharmacist on a Multidisciplinary Psychiatry Team: Impact on Medication Adherence in a Community Setting

Objective:

To report the effect of pharmacist involvement in a multidisciplinary psychiatry team managing high-risk patients in the community.

Case Summary:

We report 3 cases of professional collaboration that highlight the role of the pharmacist as a member of the multidisciplinary psychiatry team in the successful management of high-risk patients. Regular communication between pharmacists and psychiatrists, as well as delivery of specialized pharmacy services such as dispensing of medications in controlled supply, witnessed medication consumption, and adherence monitoring, resulted in decreased use of emergency services, decreased incidents of overdose, and increased adherence to medication.

Discussion:

The management of psychiatric patients poses a significant challenge to healthcare providers. Poor adherence to drug therapy is often a significant barrier to treatment success and can lead to clinical and economic burdens. Professional collaboration between psychiatrists and pharmacists can aid in successful management of psychiatric patients at risk of relapse or deterioration in the community setting secondary to nonadherence and/or possible overdose. The pharmacist is often an unrecognized or underutilized member of the multidisciplinary team. The recent focus on expanding the pharmacist's scope of practice supports the involvement of pharmacists as integral members of interdisciplinary and collaborative care models.

Conclusions:

Interprofessional collaboration and implementation of specialized pharmacy services can increase patient adherence to medication regimens, reduce the potential for overdose, and aid in the successful management of psychiatric patients in the community setting. Although we have highlighted a small number of cases, future research is required to assess the effectiveness of such interventions on a larger scale.

Peer-level patient presenters decrease pharmacy students' social distance from patients with schizophrenia and clinical depression

OBJECTIVES

To create a doctor of pharmacy curricular experience that will decrease students' social barriers to interaction with and treatment of mentally-ill patients.

DESIGN

We created a survey instrument to measure 4 aspects of students' conceptions of schizophrenia and clinical depression: (1) understanding of the medical nature of each disease, (2) understanding of patient behavior, (3) belief in the efficacy of treatment, and (4) social distance. We delivered this instrument before and after a neuropsychiatry curriculum including "peer-level patient presenters" in addition to the traditional first-year pharmacy curriculum.

ASSESSMENT

Social-distance scores significantly decreased in first-year pharmacy students who attended peer-level patient presentations, indicating increased willingness to interact with persons with schizophrenia and clinical depression. In addition, students' understanding of the causes of illness, behavior of patients, and most importantly, efficacy of drug counseling for these diseases increased.

CONCLUSIONS

Changes to the curriculum including the addition of peer-level patient presentations can quantitatively decrease pharmacy students' social barriers to the treatment of mentally-ill patients.

A comparative study of consumer participation in mental health pharmacy education

BACKGROUND

People with mental illness have been recognized as key stakeholders in the development of mental health education. However, few studies have evaluated the impact of people with mental illness as participants in education programs for students studying to become health professionals.

OBJECTIVE

To assess the impact of education provided by mental health consumer-educators on the attitudes of pharmacy students toward people with mental illness.

METHODS

The study used a 2 group, nonrandomized, clustered, comparative design, with 4 tutorial classes allocated to receive standard pharmacist-led instruction (comparison group), and 5 tutorial classes to receive standard pharmacist-led instruction plus additional input from mental health consumer-educators (intervention group). All pharmacy students (N = 229) enrolled in the third year of a 4 year pharmacy degree program were invited to participate. Consumer-educators receiving ongoing treatment for illnesses including schizophrenia, bipolar disorder, and major depression participated in small-group work, case-study discussions, and role plays with pharmacy students in the intervention group. Pharmacy students' attitudes were assessed using a 39 item survey instrument derived from previously published instruments evaluating social distance, attribution, provision of pharmaceutical services, and stigmatization of people with schizophrenia and severe depression.

RESULTS

Paired baseline and follow-up responses were obtained from 117 students in the intervention group and 94 students in the comparison group. Students who received the consumer intervention had decreased social distance scores (F(1209) = 5.30; p = 0.02). Students in the intervention group more strongly disagreed with 26 of 27 nonsocial distance statements that demonstrated a negative attitude toward people with mental illness (F(1209) = 13.58; p < 0.001) and more strongly agreed with all 4 nonsocial distance statements that demonstrated a positive attitude (F(1209) = 7.56; p = 0.014).

CONCLUSIONS

Consumer participation in mental health education for pharmacy students improves students' attitudes toward people with mental illness.

Pharmacy students' and graduates' attitudes towards people with schizophrenia and severe depression

OBJECTIVES

To compare the attitudes of third-year pharmacy students and pharmacy graduates towards people with schizophrenia and severe depression.

METHODS

Third-year pharmacy students (n = 216) and pharmacy graduates (n = 232) completed a survey instrument with 21 common items. The third-year students had not yet received any mental health lectures or tutorials as part of their pharmacy course. The graduates had completed their university education, including mental health lectures and tutorials, plus 6 months of supervised clinical practice in the pharmacy workplace.

RESULTS

There were no significant differences between the third-year students and pharmacy graduates in terms of social distance from people with schizophrenia. The rates of stigmatization of people with schizophrenia and severe depression were also similar between the groups.

CONCLUSIONS

Mental health lectures and tutorials delivered by pharmacists and supervised clinical practice in the pharmacy workplace may not decrease students' social distance or stigmatization of people with mental illness. The results of our study suggest that more comprehensive education and training programs are needed to improve the ability of pharmacists to meet the needs of people with mental illness.