CMHP Competencies

1. Professional expertise in drug therapy in psychiatry/mental health

A CMHP specialist pharmacist will be able to demonstrate and apply a thorough knowledge of drug treatment of major mental illnesses. The candidate will be able to:

Demonstrate knowledge of the relevant pharmaceutical aspects of drug treatment choice:
Demonstrate knowledge of pharmacodynamics
Demonstrate knowledge of pharmacokinetics
Demonstrate knowledge of pharmacoeconomics
Demonstrate knowledge of drug interactions
Demonstrate awareness of the principles of prescribing quality
Demonstrate an appreciation of the prescribing issues associated with special patient groups
Demonstrate the ability to apply knowledge of drug treatments to clinical situations
Interpret published papers

2. Demonstrate thorough knowledge of mental illness

A CMHP specialist pharmacist will be able to demonstrate a thorough knowledge of mental illnesses. The candidate will be able to demonstrate knowledge of:

Classification (symptoms/description)
Epidemiology
Course and prognosis
Pathology
Biological and psychological theories of mental illness

3. Communication within multidisciplinary and user forum/fora

A CMHP specialist pharmacist will be able to demonstrate evidence of effective communication skills:

Evidence of productive involvement within a multidisciplinary environment
Medicines information
Experience of productive communication with service users
Demonstrate clear, concise and effective written and oral communication skills

4. Legislation and politics

A CMHP specialist pharmacist will be able to demonstrate knowledge of the legislative and political influence on mental health care provision:

Knowledge of relevant mental health legislation
Demonstrate knowledge of the political philosophy influencing mental health care in their own country

5. Service provision and development

A CMHP specialist pharmacist will be able to demonstrate active involvement in the provision and development of the pharmaceutical aspects of mental health care:

Demonstrate a wide experience of the provision of pharmaceutical services in mental health
Be able to plan local service development to meet changing needs in mental health care:

6. Care

A CMHP specialist pharmacist will be able to demonstrate a commitment to care and an empathy with people with mental health needs:

Demonstrate a commitment to patient care
Show empathy to patients in their approach to provision of services

7. Vision and initiative

A CMHP specialist pharmacist will be able to demonstrate a vision for the future development of pharmaceutical mental health care:

Demonstrate initiative in their work
Show a clear vision for personal and service development in the future of pharmaceutical mental health services

Detailed Competences

1. Professional expertise in drug therapy in psychiatry/mental health

A CMHP specialist pharmacist will be able to demonstrate and apply a thorough knowledge of drug treatment of major mental illnesses. The candidate will be able to:

a. Demonstrate knowledge of the relevant pharmaceutical aspects of drug treatment choice:

Name the main licensed treatment options for the major ICD-10/DSM-IV mental health conditions
Explain the current theories for their probable modes of action, where of established credibility
List the major licence restrictions and/or contraindications for each
List the important (SPC requirements and good practice) monitoring requirements for those drugs
List the main adverse effects that would be expected for three specified drugs
Evaluate claims of efficacy and safety for these three drugs
List reasons for selection of a particular drug for a particular individual patient from these drugs e.g. discuss the evidence base
List the possible advantages and disadvantages of the use of combinations of drugs in three major mental health disorders
State the normal therapeutic dose for three licensed psychotropic drugs (oral, IM/IV)
Describe at least five occasions when the candidate was influential in the choice of a drug in a particular
State the tools (if any) available to evaluate the potential therapeutic effects of drugs

b. Demonstrate knowledge of pharmacodynamics

Define the term "pharmacodynamics"
Explain in simple terms how this might be of clinical significance to an individual patient

c. Demonstrate knowledge of pharmacokinetics

Explain the principles of (first and second) order kinetics, with examples
Explain how plasma levels vary with time for various routes of administration
Define the term ADME (absorption, distribution, metabolism, excretion) and explain it in simple terms
Explain in simple terms how ADME might be of clinical significance to an individual patient

d. Demonstrate knowledge of pharmacoeconomics

List the fundamental issues associated with a pharmacoeconomic analysis of drug therapy
Describe in the portfolio two pharmacoeconomic studies and their relevance, importance and weaknesses

e. Demonstrate knowledge of drug interactions

Identify and evaluate important categories of drug-drug and drug-food interactions, and the influence of the P450 and other liver enzyme systems
List two interactions from each of three selected groups of drugs or identify interactions from a given list of drugs

f. Demonstrate awareness of the principles of prescribing quality

List the main principles of drug prescribing
Provide an example of a prescribing protocol with which the pharmacist has been involved and be able to justify and constructively criticise OR, if not available, provide an example of another prescribing protocol and be able to justify and criticise it
List three published studies on prescribing quality and evaluate the implications for local practice
Give at least five examples in the last six months where an "intervention" into prescribing was necessary, and explain how the principles of prescribing were applied (through a log of events over a specified period of practice e.g. three months and submitted in the portfolio)

g. Demonstrate an appreciation of the prescribing issues associated with special patient groups

Select five special patient groups from a specified list
For each of the five groups, list three issues or cautions surrounding the prescribing of medicines

h. Demonstrate the ability to apply knowledge of drug treatments to clinical situations

List the principles of preparing a drug history
and
Answer a telephone helpline call and provide appropriate advice or
Negotiate a drug therapy change with a clinician
Provide and evaluate five examples of occasions within the last six months where the candidate has operated as a full member of a multidisciplinary team

i. Interpret published papers

Demonstrate an understanding of the application of medical statistics

2. Demonstrate thorough knowledge of mental illness

A CMHP specialist pharmacist will be able to demonstrate a thorough knowledge of mental illnesses. The candidate will be able to demonstrate knowledge of:

a. Classification (symptoms/description)

List the main symptoms of the major ICD-10/DSM-IV mental health conditions
State the difference between ICD-10 and DSM-IV

b. Epidemiology

List the main epidemiological characteristics of five major ICD-10 or DSM-IV illnesses
Illustrate these with examples from the candidates local area

c. Course and prognosis

List the likely time-course and prognosis for five major DSM-IV or ICD-10 mental illnesses
Indicate the likely influence of drug therapy on these five

d. Pathology

List main uses and limitations of laboratory tests
State the main categories of biochemical tests carried out for a selection of drugs
List two tests in each category, and for each of them identify influences of illness and drug therapy

e. Biological and psychological theories of mental illness

List three non-drug or psychological therapies used in mental health care
Briefly describe their roles in therapy and inter-relationship with prescribed drugs

3. Communication within multidisciplinary and user forum/fora

A CMHP specialist pharmacist will be able to demonstrate evidence of effective communication skills:

a. Evidence of productive involvement within a multidisciplinary environment

Name the key members of a MDT or local equivalent, and describe their roles and expertise and the role of a pharmacist
Describe the main structure of medical and nursing notes
List the main principles of the Care Planning Approach (CPA)
Describe three occasions in the last year when drug therapy had been discussed by the candidate with other professional groups
List the main types of hospital, practice and Health Authority formularies, and describe how exclusion or inclusion criteria might be developed within the candidates own setting

b. Medicines information

State the sources of information available to support an evidence-based approach to prescribing, and list their advantages and disadvantages
Discuss the use and application of IT to retrieve, record, assess and communicate medicine information
Describe the categories and levels of medicine information
Describe the categories and levels of evidence (as in NSF)

c. Experience of productive communication with service users

Describe two occasions when drugs have been discussed with users or user groups
List the issues raised by those groups and the candidates responses to them
List the principles behind therapeutic alliances with patients and give two personal examples
Describe how an individual's needs for education about drug treatment would be assessed and how different needs might be addressed

d. Demonstrate clear, concise and effective written and oral communication skills

Provide three examples of written pieces of work for different audiences (e.g. GPs, Hospital specialists, managers, nurses, users etc) in which the main issues can be clearly identified.
Demonstrate effective communication skills with a service user
Negotiate a change in drug therapy for a given patient
List four main ways in which information can be provided to fellow healthcare professionals, and provide an example of each the candidate has used in the last year.

4. Legislation and politics

A CMHP specialist pharmacist will be able to demonstrate knowledge of the legislative and political influence on mental health care provision:

a. Knowledge of relevant mental health legislation

List the main sections of the relevant Mental Health Act:
England and Wales (Mental Health Act 1983) or
Scotland
Describe the role of the pharmacist within the relevant MHA

b. Demonstrate knowledge of the political philosophy influencing mental health care in their own country (relevant items from this list)

Describe the Governments current strategy for mental health care
List the seven main standards within the National Service Framework for mental health (or your countries equivalent), and the implications for pharmacy
Describe the implications for pharmaceutical care of:
Bournewood Judgement
Caldicotte
Access to Health Records Act
Medical records and confidentiality
Clinical governance
NICE/National Standards Board for Scotland
Primary Care Groups and Trusts
Supervision registers
Assertive outreach

5. Service provision and development

A CMHP specialist pharmacist will be able to demonstrate active involvement in the provision and development of the pharmaceutical aspects of mental health care:

a. Demonstrate a wide experience of the provision of pharmaceutical services in mental health

Explain the pharmacist's roles in two mental health specialties, including external factors (e.g. legislation), MDT, place of drugs and other therapies, factors affecting drug choice
For each area listed above, describe four examples where the candidate has had a positive input.
Describe three other specialties, giving the pharmaceutical aspects and implications of care
List three non-NHS statutory or non-statutory bodies or agencies that provide some level mental health "care" in the candidates locality and describe their roles and importance
Describe the principles of clinical audit

b. Be able to plan local service development to meet changing needs in mental health care:

Describe examples of two proposed service developments, including objectives, business plans, proposed measures of success etc (the candidate does not need to have been directly involved)
Describe how these could be, or could have been, implemented and the problems likely to be encountered
List three main developments (from different levels of organisation e.g. department, Trust, Authority/Board) occurring in mental health care provision locally and how pharmacy services could or should react to these

6. Care

A CMHP specialist pharmacist will be able to demonstrate a commitment to care and an empathy with people with mental health needs:

a. Demonstrate a commitment to patient care

List three occasions in the last six months when the candidate has provided a commitment to provide individual pharmaceutical care
Describe the outcome for the patient and/or carer(s) for each occasion

b. Show empathy to patients in their approach to provision of services

Outline the cultural and gender issues in mental illness
Describe the application of the principles and practices of anti-discriminatory and anti-racist practice
List the main issues and implications of patient confidentiality

7. Vision and initiative

A CMHP specialist pharmacist will be able to demonstrate a vision for the future development of pharmaceutical mental health care:

a. Demonstrate initiative in their work

Describe five examples (within at least three different categories) within the last year of occasions when personal initiative was used to improve the pharmaceutical care for an individual patient or group of patients

b. Show a clear vision for personal and service development in the future of pharmaceutical mental health services

Describe how the candidate would like their own service (either as head or a team member) to develop over the next five years
Describe what the development needs are for themselves or others to facilitate this, how they might be achieved and the problems likely to be encountered
Describe the service development needs to achieve this
List some of the areas where development of the pharmacists role might occur in psychiatry/pharmacy in general
Demonstrate a commitment to Continuous Personal Development through a log of activities over the previous year

Notes:

Some of these items are part of the portfolio and some will be assessed through the viva.
Holders of the Certificate or Diploma may be able to use data gathered from their portfolios for items in this list as mentioned in the portfolio document.
This list of competencies will be subject to continuous review to ensure it meets the needs of the CMHP to accredit members in lines with the principles of Clinical Governance.