Bigger role for pharmacists in mental health treatment

Supporting pharmacists to deliver mental health care in Australia will lead to earlier intervention, improved treatment outcomes and a reduction in medication harms.

This is the message in the PSA response to the Productivity Commission’s Draft Report on Mental Health, released in October.

Five areas for reform were set out in the draft report:

• prevention and early intervention for mental illness and suicide attempts
• closing critical gaps in health care services 
• investment in services beyond health 
• assistance for people with mental illness to get into work and enable early treatment of work-related mental illness
• care coordination, governance and funding arrangements.

But PSA argues the report failed to tackle the problems with medicine use in mental health, or the challenge of improving the use of medicines in the treatment of mental illness.

‘People with mental ill health are being denied the best opportunity to improve their health when a medicine is prescribed due to barriers in the use of the expertise of pharmacists, especially in the context of tailoring therapies using personalised approaches,’ the PSA response said.

‘People are also prevented from having the opportunity for regular review of their medicines to ensure that medicines used for mental ill health are delivering their desired effects, helping people, not harming people.’

Medicines review

Nearly 40 million mental health-related medicines were supplied to 4.3 million Australians – 17.1% of the population – in 2018–19.

The proportion of the population receiving mental health-related medicines in Australia has risen by about 0.9% each year since 2013–14, while antidepressant use has risen 10-fold since 1990.

PSA National President Associate Professor Chris Freeman said it is impossible to address mental health challenges without considering the quality use of medicines. 

‘Medicines are a major treatment modality in most mental illnesses, so it is disappointing the Productivity Commission report failed to question how we can improve medication efficacy and safety,’ he said.

‘Utilising the medicine expertise of pharmacists in the multidisciplinary care team, tailoring medication therapies and reviewing patients’ medication management can positively impact adherence, effectiveness of medicines prescribed and safe use of medicines.’

A 2017 report from the Australian Commission on Safety and Quality in Health Care (ACSQHC) found more than 80% of people with a psychotic illness endure unpleasant side effects from their medicines. It also found one in three live with moderate to severe impairment due to side effects.

PSA is calling for better use of pharmacists’ skills for closer monitoring of real-time psychotropic medicine use in the community, along with the opportunity to better support consumers and carers to manage side effects, adherence and the risks of self-harm and poisonings.

The pharmacist’s role

Almost half of all Australians experience mental ill-health during their lifetimes. As the most accessible health care professionals and, in some cases, the only front-line health care providers in a community, pharmacists should be empowered to identify, triage and support people with mental ill-health.

‘Access to health care is vital for people dealing with mental health illness, yet there are a range of barriers that can limit people’s access to a general practitioner,’ A/Prof Freeman said.

‘With the majority of Australians visiting their pharmacist around 14 times a year, our profession can help care for and triage patients experiencing mental ill-health or a mental health crisis.’

Pharmacists should also be integrated into suicide prevention strategies. A 2019 survey of more than 400 community pharmacists in Australia and Canada found that 85% had interacted with someone at risk of suicide at least once, and 10% had interacted with someone at risk of suicide more than 10 times.

‘Enabling pharmacists to recognise potential signs and symptoms of mental ill-health, support patients and refer to GPs or emergency care, has the potential to not only improve outcomes, but potentially save lives,’ A/Prof Freeman said.

‘We have called on governments across the nation to provide funding to increase pharmacist mental health first aid training and reiterated this recommendation in our response to the Productivity Commission.’

PSA’s 5 key recommendations:

1. Develop and implement regular reviews of medicines for people with mental ill-health to reduce the time to respond to medicine-related problems and to reduce debilitating adverse effects from medicines that can be preventable.
2. Incorporate pharmacogenomic testing in primary care supported by medicines expertise of pharmacists for people with mental ill-health to personalise medicine therapies to improve the safe and quality use of medicines.
3. Integrate pharmacists in suicide prevention strategies, including supporting pharmacists in their triage role of providing support to people they encounter in mental health crisis situations.
4. Support pharmacists, who are often one of the only front-line health care providers in rural and remote regions to incorporate early identification, triage and support for people with mental ill-health.
5. Ensure pharmacists, as frontline health professionals in contact with people with mental ill-health, have the required expertise such as mental health first aid, to support early identification, triage and support for people with mental ill-health.

The final report of the Productivity Commission is due to the government in May.