Introduction of a Mental Health Medicines Education Service

An introduction : Phoenix Pharmacy Department (PPD) provides hospital pharmacy services to the Phoenix Care Centre (PCC) and to Dublin North City Community Mental Health Services (DNCMHS). PCC is a 54 bed facility split into two psychiatric intensive care units (PICUs) and two rehabilitation units. PCC PICUs provide a tertiary referral service for a catchment area of 2,060,7191. Clinical pharmacists attend weekly multidisciplinary team (MDT) meetings, carrying out medicine reconciliation and optimisation. PPD recognise the problem that mental health (MH) service users (SUs) often do not seek out or fully engage with services2, 3. On this basis PPD identified an opportunity to enhance engagement and quality of care by introducing a medicines education service. Short description of practice change implemented Pharmacist led medicines information sessions now held in PCC Pre-discharge individual sessions Weekly group sessions New community-based medicines information program in the Recovery Hub4 Pharmacist delivering the medicines component of Eolas programme5 Aim and theory of change Expanding SU’s knowledge of medicines Improving health literacy through supporting self care Empowering SUs in their own recovery Targeted population and stakeholders PCC Inpatients Other health care professionals (HCPs). DNCMHS community SUs and their families/carers Timeline : Pharmacy Clinical Service to PCC (attending MDTs) set up in June 2014 and expansion of service to include medicines education service commenced in March 2016. Highlights: (innovation, impact and outcomes) Pharmacists are ideally placed to provide medicines education on both physical and mental health; thus bridging the gap between primary, secondary and tertiary services.  Pharmacists can then advocate for SUs, and influence prescribing, based on SU experience and beliefs. Outcomes were measured through feedback forms and responses were very encouraging.  The knowledge and time given by pharmacists was greatly appreciated. Comments on sustainability : Addition of two new clinical pharmacists in March 2016 enabled the provision of this service. Comments on transferability : Comprehensive clinical pharmacy services are transferrable but resources may limit widespread availability. Conclusions : (comprising key findings) Evidence-based medicines information is now routinely provided to SUs, both on demand, and proactively, by clinical pharmacists.  SU’s/carers overall understanding of their medicines has been greatly enhanced. Discussions : Medicine education sessions, now available in both hospital and community settings, empower SUs and their families/carers. These sessions promote self care and improve health literacy6. Lessons learned : Medicines education sessions increased pharmacist-patient contact and increased pharmacist job satisfaction. The needs of this vulnerable MH service user group are similar to the needs of patients with any physical health issue and provision of information services should be comparable.  Historically MH stigma has discriminated against MHSUs and created barriers against adequate treatment7. Our initiative is helping to overcome such barriers and optimise the quality of care. Feedback from SUs and other HCPs regarding the impact of direct contact with a clinical pharmacist has highlighted that this is a valuable service that needs to be available routinely throughout our national MH service. References : 1- Health Intelligence Unit, Health Service Executive (HSE). Health Atlas Ireland. Dublin: Health Intelligence Unit; 2011. Available from: www.healthatlasireland.ie. [Accessed 8th December 2016]. 2- Horritz-Lennon M, Kilbrourne A, Pincus H. From Silos To Bridges: Meeting the General Health Care Needs of Adults with Severe Mental Illnesses. Health Affairs 2006; 25 (3): 659- 669. Available from: http://content.healthaffairs.org/content/25/3/659.full.html. [Accessed 8th December 2016]. 3- Corrigan PW, Druss BG, Perlick DA. 2014. The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care. Psychological Science in the Public Interest 2014; 15 (2): 37-70. Available from: https://www.researchgate.net/profile/Deborah_Perlick/publication/279239872_The_Impact_of_Mental_Illness_Stigma_on_Seeking_and_Participating_in_Mental_Health_Care/links/55d4a28208aef1574e9756aa.pdf. [Accessed 8th December 2016]  4- Recovery Hub, North Circular Road, Dublin. Dublin North City Community Mental Health Services Activity Centre. Available from:  https://www.eve.ie/HUB  [Accessed 9th December 2016]. 5- Eolas Mental Health. Eolas Project. Kildare: The EOLAS Project; 2016. Available from: http://www.eolasproject.ie/home . [Accessed 8th December 2016]. 6- Nutbeam D. Defining, measuring and improving health literacy. World Health Organisation, 2015; 42 (4): 450-6. Available from: http://www.who.int/global-coordination-mechanism/news/Health-literacy-WHO-Geneva-Nov-2015.pdf?ua=1. [Accessed 8th December 2016]. 7- Ahmedani B. Mental Health Stigma: Society, Individuals, and the Profession. J Soc Work Values Ethics 2011, 8 (2): 4- 16. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3248273/. [Accessed 8th December 2016].