RPSGB MENTAL HEALTH TASK FORCE GUIDELINES 2000

In September 2000, the RPSGB Mental health Task Force Guidelines were launched. There follows:

  1. Report from the Pharmaceutical Journal
  2. Link to RPSGB site where you can download the guidance (provided you have Acrobat reader)
  3. Task Force member and UKPPG Chairman Stephen Bazire's thoughts

The Pharmaceutical Journal Vol 265 No 7114 p403, September 16, 2000

Launch of Society guidance on respiratory disease and mental health

Two sets of guidance produced by Royal Pharmaceutical Society task forces - one on respiratory disease and one on mental health - were launched at the conference on September 11.

Launching the guidance on mental health, Mr Hassan Argomandkhah (chairman of the Society's mental health task force) said: "Pharmacists across all sectors have the potential to get more involved in the care of patients with poor mental health." He added that the guidance provided information that would help pharmacists extend their existing services and "make the move forward". Mr Stephen Bazire (pharmacy services director, Hellesdon hospital, Norwich) added that medicines in mental health were a big issue, as they were often "badly used". Pharmacists were often not up to date in this area and were not assertive in asking for changes to medication to be made. "Supply is not the end of the pharmacy service, it is the beginning," he said.

The Pharmaceutical Journal Vol 265 No 7114 p390-392, September 16, 2000

Guidance issued on mental health.

The Royal Pharmaceutical Society has produced two new sets of practice guidance, one covering mental health and the other asthma and chronic obstructive pulmonary disease. They were launched at the British Pharmaceutical Conference on September 12. Edited versions of their executive summaries are given below

Caring for people with mental health problems

Mental health is one of the Government's three "supercharged" priorities (alongside cancer and coronary heart disease) as identified in the Government White Paper "Saving lives: our healthier nation".

The national service framework (NSF) for mental health was published on September 10, 1999, and sets out seven national standards for mental health. The NSF also addresses national service models, local action and underpinning programmes for implementation. It includes both health and social services and covers the mental health of adults up to the age of 65 years.

Partnerships are important in mental health, because their absence could be a potential cause of poor services, whereas improved partnership working can potentially benefit all parties. Where an individual's care breaks down, inquiries and audits often conclude that poor joint working and communication, together with a lack of accountability, were key factors.

The Government's agenda for modernising health and social services has a core aim of partnership between all the key stakeholders in any area of service provision. The NSF provides some guidelines to all agencies involved in delivering mental health services, whether they be mainstream, specialist, statutory or voluntary sectors. Although the NSAF guidance focus primarily on England, we consider that it embodies generic principles of good practice in the delivery of mental health services by pharmacists and should, therefore, be broadly applicable to Scotland and Wales.

A mental health task force convened by the Society has written guidance specifically aimed at pharmacists. The role of health and social care professionals in implementing the NSF for mental health is described, taking a specific focus on pharmacists working in the community, in secondary care, or in commissioning.
Each of the seven NSF standards is explored, with their implications for pharmacists and suggestions for ways forward. Many practice examples are provided that will be of interest to pharmacists wishing to take the guidance forward. The Society's guidance on caring for people with mental health problems is aimed at pharmacists working in all aspects of the health care system, for example:
Community pharmacists

The guidance will also be useful for those interested in understanding more about the role of pharmacists in the current mental health policy context. For example:

Implementing the NSF
The vast majority of people with mental health problems live in the community, with most accessing services through primary care. It is estimated that as much as 90 per cent of mental health care is provided in primary care settings. Pharmacists are therefore key partners with other primary care providers, mental health service users and carers in the delivery of effective mental health care.
The NSF sets its seven standards in five areas and the role of pharmacists in each of these areas is highlighted:

Mental health promotion: standard one Community pharmacists have a key role to play in health promotion, being able to engage effectively with vulnerable groups known to be at risk of developing mental health problems, eg, women suffering from post-natal depression. Possible activities for pharmacists are:

Primary care and access to services: standards two and three Community pharmacists Community pharmacists already play an important role in the provision of services to people with mental health problems and, for many, there is scope to develop their services further. Outlined below are some of the areas in which community pharmacists might become involved:

There is also a role for community pharmacists, particularly those interested in developing their role in the area of mental health, to work with members of the community mental health team (CMHT), focusing on areas such as care planning and continuing professional development.

Pharmacists in secondary care There is considerable scope for pharmacists to develop services in secondary care settings. The developing role of specialist mental health pharmacists is particularly important. Service developments could include:

Effective care for those with severe mental illness: standards four and five Since medicines are an important component of follow-up care, several areas need to be integrated in relation to the care of people with severe and enduring mental health problems:

Caring for carers: standard six It is estimated that the number of relatives, friends and professionals acting as carers for people suffering from schizophrenia alone could number over 400,000. Pharmacists frequently deal with carers, possibly more so than with mental health service users. Social services departments have a duty to assess the needs of all carers, including carers of people with mental health problems, and have responsibility for implementing this standard under the Carers Act 1999.

Community pharmacists can play a continued and enhanced role by providing information about medicines (eg, benefits and side effects), by dealing with compliance issues) and by contacting the local SSD or referring a carer to the local SSD to have their caring needs assessed, eg, respite or domiciliary care.

dditionally, pharmacy academic practice units and schools of pharmacy could work with local SSDs, education and training consortia for health care workers and colleagues in other sectors to assess the educational and training needs of carers relating to the use of medicines and to develop courses to meet those needs.

Prevention of suicide: standard seven This standard relates to national targets for reducing suicide rates. The NSF suggests that this will be achieved by the combination of standards one to six. However, some drugs have been clearly shown to reduce the likelihood of suicide in those who are at high risk of overdosing on medicines. Specialist mental health pharmacists clearly have a role in keeping abreast of this evidence and disseminating it to primary care professionals, community mental health teams and other service providers.

Moving forward
All pharmacists working within patient care settings will be involved to a greater or lesser extent in the provision of services to people with mental health problems. This guidance provides some suggestions for those pharmacists wishing to play a more active role.

Improved communication will be a critical success factor for all involved in mental health care provision and should be a key target for pharmacists. This involves communication with service users, carers, other pharmacists and members of the CMHT. Good communication hinges on confidence and confidence will increase with experience and competence. The guidance concludes by focusing on three main areas:

Checklist A checklist is provided, which highlights the importance of a collaborative approach, which involves networking with pharmacists and other practitioners locally and, where appropriate, nationally.

Practice examples and guidelines The Society's mental health task force has collated details of recent projects involving pharmacists. These are examples of what has already been done in this area and are intended to help pharmacists identify areas in which they may wish to develop services. The information is contained in the appendices of the report.

Training and education needs There is a significant training agenda for all professionals in the delivery of mental health services. For pharmacists wishing to become more involved in this area, there is a need to identify relevant and appropriate training needs. For example, advances in psychiatric therapeutics have taken place over the past 10 years, bringing a need for pharmacists to update their knowledge of current and developing drug therapy. It is useful to have knowledge of the alternative and psychological therapies available to patients and to recognise their place alongside medication. In addition, an appreciation of the role of other members of the multidisciplinary team also facilitates a broader appreciation of the many problems frequently encountered in the management of acute and chronic mental health problems. The guidance identifies a number of agencies that are already providing relevant post-qualification training.

Conclusion
Multidisciplinary working is the only way to help deliver the objectives of pharmaceutical care in the context of mental health care. The guidance issued by the Society offers advice across major sectors of pharmacy practice. Improvements in co-ordination and focused effort on the development and provision of services could have a significant impact on improving pharmaceutical care for many patients with mental health needs, with benefits also for their families and carers.

How to obtain copies

Copies of the guidelines can be downloaded from the Society's website as PDF files (www.rpsgb.org.uk/pdfs/mhealthguid.pdf). Copies may also be obtained from Ms Angela Canning, Royal Pharmaceutical Society, 1 Lambeth High Street, London SE1 7JN (tel 0207 735 9141 ext 270; fax 0207 582 3401; e-mail acanning@rpsgb.org.uk)

RPSGB Mental health Task Force

At the British Pharmaceutical Conference in Birmingham on 12.9.00, the "Practice Guidance on the Care of people with Mental Health Problems" produced by the RPSGB Task Force on Mental Health were formally launched. The session, chaired by Hassan Argomandkhah (Task Force Chairman and Council member), featured Task force members Janis Stout (Social worker, NW education consortium), Andrew Curry (CMHN, Dorset) and Stephen Bazire (Norfolk, but not acting on behalf of the UKPPG) to outline the contents. What follows is Steve’s synthesis (or spin) on the contents.

In his presentation, Steve mentioned that there were many problems facing pharmacy e.g. medicines are a "big issue", with a high risk to users of getting medicines wrong, prescribing of psychotropics was frequently poor or non-evidence-based (e.g. antidepressants, antipsychotics), education of users and carers about their medicines is generally poor or non-existent, there is variable and conflicting information available and pharmacists (and many others) are not necessarily up-to-date or assertive enough. An example scenario is that e.g. in secondary care, a new drug is prescribed for a patient on a ward, the patient only finds out about it at the next drug round and then receives little or no information until, if they are lucky, they get "counselling" and/or an information leaflet (or neither) on discharge. The patient and is then left with only a few sources of information and advice e.g. GP, family, friends, Community Pharmacists, Internet etc. In primary care, a GP may prescribe drug during a short consultation, and relies on the community pharmacist to counsel or give out information leaflets. Worse still is the out-patient scenario, where a junior or perhaps staff grade doctor advises, the GP prescribes on this advice, the community pharmacist dispenses and none know what they're doing.
The ideal scenario (delusion might be a more accurate term) for secondary care would be that an RMO agrees a diagnosis and strategy, a pharmacist agrees the drug, dose and monitoring, counsels that patient before starting the drug, follows this with full education about drug (e.g. mode of action, the how and why of side effects, tolerance/dependence/addiction, duration of treatment etc), a comprehensive discharge package is provided, followed by transfer to a Community pharmacist, follow-up by Liaison Pharmacist in conjunction with a Community Pharmacist, with support to the patient, carer, relatives and the community pharmacist by secondary care e.g. helpline, books etc. There is then follow-up from fully trained and supported professionals e.g. CMHNs, advocates, self-help groups, carers etc and referral facility direct from primary to secondary care and vice versa.
The purpose of the RPSGB producing these mental health guidelines was that there are huge problems with the use of medicines in mental health, and that pharmacists can help solve many of them, by promoting "joined up pharmacy", recognising strengths and weaknesses of branches of profession. Subsequently, the guidelines are aimed at all pharmacists, but especially pharmacists with open minds. This would thus include Community pharmacists, Secondary care generalists, Secondary care specialists, LPCs, Commissioners/PCG/PCTs, Academia (Schools and APUs), Specialist groups and Prison pharmacists. The guidance is presented in the format and order of the National Service Framework for mental health (England) standards.

Guidance for the branches of the profession (in no particular order)

Secondary care – specialists

Specialist mental health pharmacists should:

Secondary care - generalists

Primary Care Pharmacists

Essential services, should be provided by all:

Extended services:

With a CPD commitment (initial and on-going), more advanced services can be provided e.g.

Commissioners e.g. PCTs, PCGs, Health Boards etc

Specialist Pharmacy Groups

Academia

Continuous Personal Development

The whole premise of the guidance is that if you provide specialist services there must be a CPD commitment. This can be via a number of examples:

The profession

Other prominent pharmacists who were involved in the Task Force included Annie Coppel (NPC), John Donoghue and Portia Omo-Bare (London). Other members included Margaret Edwards (SANE), Prof Rob Kerwin (Maudsley), Dr Chris Manning (GP). Not forgetting Janet Flint and Jane Lapon (Practice Division, RPSGB) for the hard work, plus Hemant Patel, former President RPSGB, who started the ball rolling in the first place. Many other people, e.g. Dave Branford, Susan Abell, Celia Feetam etc contrinuted to the document.

The 75 page document has a summary, practice guidance (ie ways of working, rather than clinical guidelines), examples of good practice and contacts.

How to obtain copies

Copies of the guideline can be downloaded from the Society's website as PDF files (www.rpsgb.org.uk/pdfs/mhealthguid.pdf). Copies may also be obtained from Ms Angela Canning, Royal Pharmaceutical Society, 1 Lambeth High Street, London SE1 7JN (tel 0207 735 9141 ext 270; fax 0207 582 3401; e-mail acanning@rpsgb.org.uk)