The CPPE mental health programme and campaign aims to raise the profile of mental health conditions and to explore how pharmacy professionals can improve their support for people living with mental health conditions. This will help ensure that those with mental health conditions and physical health conditions receive parity of treatment. This article contains some of the information in the learning material and campaign. At the end of this article you will be able to:
· Define mental health
· Outline the relationship between mental health and physical health
· Describe how to support a patient to consider the risks and benefits of their treatment
Why mental health?
“When I first started taking my medications – citalopram, zopiclone and diazepam – I wanted to know what to expect. My GP told me to read the leaflets that come with the medications for more information on side effects. This scared me so much that I didn’t take any of them for three weeks after collecting my prescriptions. I finally spoke to a pharmacist. They reassured me that most of the side effects were very rare and what to do if I did experience any.”
Pharmacy professionals can play an important role in helping to improve the lives of those living with mental health conditions. By guiding people to optimise lifestyle choices you can support wellbeing, resilience, and independence and even reduce premature mortality.
What is mental health?
We all have mental health and it influences how we feel about ourselves and how we interact with the world around us, from communication to dealing with life events. Mental ill-health is very common and can affect anyone.
· At least one in four people will experience a mental health condition at some point in their life, and one in six adults have a mental health condition at any one time.1
· Mental health conditions can affect anyone at any time, including new mothers, children, teenagers, adults and older people.
· People with severe mental health conditions have an average reduced life expectancy of between 16 and 25 years.
· People with a mental health condition are almost twice as likely to die from coronary heart disease as the general population, four times more likely to die from respiratory disease and are at a higher risk of being overweight or obese.
· Some people can, and do recover from mental ill health; others manage their conditions.1
The national No health without mental health policy defines good mental health as a positive state of mind and body, feeling safe and able to cope, with a sense of connection with people, communities and the wider environment. Levels of mental health are influenced by the conditions people are born into, grow up in, live and work in. http://bit.ly/2wduyGe
Mental health and physical health
According to the Royal College of Psychiatrists, we should be striving for parity of esteem, where mental health conditions and physical health conditions are treated equally. By looking at a person holistically you will treat physical health conditions and mental health
conditions together, taking responsibility for the whole health of that person, so no one develops a new health condition that slips through the gaps.
Sometimes it can feel daunting when people have a lot of changes to make, and they may doubt if these are achievable. As a healthcare professional it is really important that you empower people with information and support.
· Introduce information or advice on lifestyle, diet, and exercise from the offset so that patients can be empowered to make healthy choices as soon as they are able to.
· Poor dental health can exist due to side effects of medicines, such as dry mouth or through lack of self-care. People with eating disorders can be at particular risk, as vomiting can cause enamel erosion and restrictive diets can reduce calcium levels. Many of the health promotion messages are the same as those given for other physical health conditions.
· Ensure all health checks and monitoring tests are kept up to date.
· New condition or side effects? Investigate new symptoms as you would for other health conditions, don’t assume.
· Have a look at Arthur Boorman’s story – it may inspire you to believe in people when the odds are stacked against them. Follow the link www.youtube.com/watch?v=qX9FSZJu448
1. Watch this video; it highlights the differences between how people currently perceive mental and physical health conditions. http://bit.ly/2w4yWI1
2. After you have watched the video, consider your own perceptions of mental health conditions and how these compare with physical health conditions. You could discuss your thoughts with a colleague. Think about how the video’s message can help change the way you and your colleagues might approach the care of all patients.
3. Next time you are on pharmacy placements, ask what initiatives are available to help support patients with lifestyle changes? Do you they have leaflets on various topic areas? You can read more about the relationship between mental and physical health on the Mental Health Foundation website: www.mentalhealth.org.uk/a-to-z/p/physical-health-and-mental-health
4. A Case study: Ryan O’Neill is 24 years old and has a diagnosis of paranoid schizophrenia and been prescribed clozapine. Follow the case study to explore the physical side effects of clozapine, the monitoring required and other medicine interactions. www.cppe.ac.uk/gateway/mhc#tt-mhc-c3-E-00
Risks and benefits of treatment
“After a decade of suffering with depression I finally began taking anti-depressants. The first month was horrendous. Yet when I became used to the medicines, I realised a significant
change in my mood; I felt motivated to get out of bed” and go to work.”
It is important that all patients
It is important for all patients to understand the medicines they are being offered and the risks and benefits of treatments. Pharmacy professionals in all sectors are in an ideal position to help people make informed decisions about their treatment. Consider your knowledge of treatments for mental health. You may use resources like a psychotropic drug
formulary at your trust which outlines treatments available, doses, links to guidance and the evidence base. But remember it is one thing to know the guidance, but you also need to think about how will you explain information to a patient in a way that is helpful to them at that time. Think about the words that you will actually use.
· Communicate the risks and benefits of treatment in a way that is meaningful to the patient.
· Be aware of the non-medical treatments that patients may be offered (see NICE guidance for their specific condition.)
· Whilst all medicines carry risks of side-effects, it is also important to be aware of the potential negative impact of not offering any treatment.
· Discuss side effects with the patient, eg, Parkinsonian effects when taking first generation antipsychotics (haloperidol) or potential weight gain when taking a second generation antipsychotic (olanzapine). These can be found listed in the BNF.
· Explore the most appropriate times to take medicines: sedative medicines can be taken at night to help sleep, alerting medicines can be taken in the morning.
· Don’t forget to check if there are there any interactions with over-the-counter medicines the patient may have bought? For example, St John’s Wort can interact with many medicines altering their plasma concentration, or ibuprofen can increase the risk of lithium toxicity.
Some people are put off taking medicines because of the possible side effects. Consider how you would talk to your patients about the side effects of their medicines. It is best to have this conversation when a patient is starting a new medicine. You can provide reassurance and enable the person to make an informed decision about their treatment options. Consider how you can provide information in a useable format for the patient.
1. Listen to Helen Chuck, a mental health nurse, to see how she approaches her patients and the common areas where the pharmacy team can have a great impact.
2. The Lester tool is a useful resource to monitor the physical health of patients experiencing severe mental health issues. Look at how you could use this tool in your future practice to improve support for patients. http://bitly.com/2uSzEEm
3. How would you support your patients if they are choosing not to take their medicines? What are the risks and benefits? This Mind resource provides you with information from patients and considers why they may wish to halt treatment. http://bit.ly/2x7giw0
This article considered the definition of mental health, the relationship between mental health and physical health and the risks and benefits of treatment. As a BPSA member you can access the full CPPE Mental health: support for people living with mental health conditions programme and campaign material – topics include mental health first aid, wellbeing and covert administration of medicines. You will need to register with the CPPE website, this is quick and free of charge, instructions are below:
How to register with CPPE and access the mental health learning campaign materials for pharmacy undergraduates
Step 1 – register as a Non-GPhC Registrant
• Go to the CPPE website: www.cppe.ac.uk and click Login on the top right of the screen.
• Click Register on the right-hand side.
• Click Non-GPhC Registrant under the header Register on the right-hand side of the screen.
• Fill in all the mandatory fields on the registration form.
• Read and agree to the CPPE terms and conditions.
• Click Register at the bottom.
Step 2 – logging into the CPPE website
• Go to the CPPE website and click Login on the top right of the screen.
• On the left-hand side enter your email address and your password. A confirmation email will be sent to your email address. You will need to click the link in that email to complete the registration process.
Step 3 – viewing the mental health learning programme and campaign materials
• Go to https://www.cppe.ac.uk/mentalhealth
CPPE national pre-registration tutor lead
1. Department of Health. No health without mental health. 2011.