Why did you become a pharmacist?
During my childhood whenever I visited friends and family in a hospital who weren’t well or when I went to the pharmacy which wasn’t far from our house I was struck by how very well respected the pharmacist was as part of the healthcare team. I also noticed how well they worked alongside other healthcare professionals and had so much expertise and knowledge about medicines. I was impressed by how much they helped people take care of themselves and manage their medication. Later on, at school, I developed a keen interest and ability in chemistry which propelled my interest further. That all sounds very idealistic and viewed through rose-coloured glasses but I was very young.
Could you describe your career pathway so far?
On the face of it, I think if someone was to read my CV they might think that my “pathway” has been planned or strategically thought through. This is not the case. On balance I would say I have made the very best use of opportunities that I have come across or have been presented serendipitously. I have been very lucky to have a wonderful range of experiences and a variety of jobs in different healthcare settings and with many different teams. In addition, I have also been lucky to been provided with opportunities to undertake postgraduate qualifications which have been funded in terms of money, time and support from the pharmacy departments and managers with whom I have worked.
I have had roles in primary care, secondary care and at the interface in both general medicine and mental health/psychiatry. In addition, I have been exposed to opportunities to lead on innovative service developments and be autonomous in making decisions on initiating and pushing projects forward. In fact, my career to date has been split approximately equally between general medicine and mental health/psychiatry and my postgraduate diplomas also reflect this. I am at the point now where I am embarking on the next steps and adventures in my career undertaking research as part of a PhD with Aston University whilst continuing clinical practice.
You have an interest in mental health pharmacy. Why?
If I might I would like to rephrase this if I may? I would say I have always had an interest in mental health, mental ill-health and the treatment and care of mental health. The main reason from this, if I am honest, stems from my personal experience of witnessing first-hand the impact of (untreated) mental illnesses from a very young age. Since I started practising as a pharmacist I have felt the call to work in mental health. I was lucky to be provided with an opportunity to work at a mental health trust around 11 years ago and since then I haven’t looked back. I feel that I should use my expertise, knowledge and understanding of medicines and how they work as well as my personal experience in a positive way to improve care. (Hope that doesn’t sound like I am trying to be too heroic)
One key factor that I would say that has been pivotal in my current role is that I currently work in a department that is led by a fantastic management team and I have been supported and pushed to improve my work. The people I work with across my NHS trust are wonderful and I have been privileged to have formed some good professional relationships which have blossomed. In addition, I feel that I have had many doors opened to allow me to fulfil my ambitions and aspirations as well as do things that I had never thought of before.
Are there any particular traits or skills that pharmacists who specialise in mental health need?
They are no different from the traits or skills that I would expect from a pharmacist working in any other area of patient-facing healthcare setting. I would say that mental health pharmacists compared to other pharmacists may over time develop a greater degree of emotional resilience, compassion and empathy as a consequence of the particular challenges faced within psychiatry. Other skills that are honed during practice, that facilitate a better quality of interaction with service users, their carers and the rest of the team, include perception and sensitivity as well as being able to reason both inductively and deductively. My subjective experience is that I have used and applied my pharmacological knowledge more in psychiatry than in any other setting that I have worked in.
What contribution to caring for people with mental health issues would you expect from a community pharmacist?
Community pharmacists are the most frequently visited healthcare professional in the UK. They have a role to play in asking someone how they are having to provide a point of contact where someone feels comfortable to ask for advice. In addition, community pharmacists often come in to contact with community psychiatric nurses, who visit the pharmacy with service users, their carers on their behalf. As such community pharmacists can be the first link to pick up on the fact that a service user might have stopped taking their medication or is acting out of character. Community pharmacists can provide advice on side effects and their management as well as encouraging adherence.
Interestingly I am exploring this as part of my PhD research. We are exploring the role of pharmacy in physical health in mental health. It is vital that we get the views of community pharmacists and technicians on the role of pharmacy in supporting the physical health of individuals with severe mental illness (e.g. schizophrenia). If you would like to know more about my PhD research project and/or be involved please have a look at our webpage.
Do you think suicide prevention techniques should be taught to community pharmacists?
You should have a look at work from Hayley Gorton (Senior Lecturer in Pharmacy Practice, University of Huddersfield) – she is the expert on this. Hayley’s PhD was about the pharmacoepidemiology of suicide and self-harm. From this work, there was reflection on what community pharmacy teams can do to raise awareness and help prevent suicide and self-harm.
In my opinion, yes, absolutely. Community pharmacists are the most frequently visited healthcare professional in the UK. Patients often choose to visit a particular pharmacy regularly for many years and have a trusted therapeutic relationship with the pharmacy team and the pharmacist. The position of the pharmacy team within the community means that they may be able to identify changes in medical, social and personal factors as well as the wellbeing of their patients. Pharmacy support staff may enhance this as the first point of contact in the community pharmacy where the pharmacist might not be the same person every day. The opportunity exists to signpost to national support groups or local services.
Red flags such as excessive quantities or frequency of over the counter medication could be picked up by the community pharmacy team. In doing so this could prevent poisoning by accident or suicide. Straightforward interventions of reminding of the maximum doses of, for example, paracetamol could be effective. In addition, pharmacist identification of medication implicated in overdose during a clinical check would be very valuable and trigger additional counselling of the patient and their carer and discussion with the prescriber if necessary. Counselling of patients who have been started on antidepressants is another important role that should not be overlooked – there is a need to emphasise time take to get the full benefit as well as the increased suicidality that may occur.
I would also include pharmacists who work in A&E as they might encounter individuals who have taken overdoses and they may be involved in post-discharge care. Pharmacists who work in GP practices might have a role with regards to reducing risk where smaller quantities of medication are prescribed by the GP to reduce risk. All pharmacists can be involved in recommending medication which has lower toxicity in overdose.
What has been your proudest moment so far as a pharmacist?
I was able to sit down with a service user and discuss different antipsychotic drug choices and discuss the pros and cons of each. After this discussion, the service user was able to make an informed decision about which one might be the most suitable and this was discussed with the multi-disciplinary team in the ward round. I was able to follow this up and the service user has been adherent to the medication since that discussion took place.
As a profession how should we reward pharmacists for outstanding practice?
Highlighting and reporting achievements and good practice in-house, locally, nationally and internationally– but not restrict this dissemination to pharmacy world only – share across disciplines.
Increase investment in training and opportunities
A lot of this lies fundamentally in individuals and teams reporting or having opportunity and platforms to report on the outstanding practice. As well as recognising that it is outstanding in the first place – I think traditionally pharmacy hasn’t always been good at “blowing its own trumpet”. So instilling this early on in pharmacy training is fundamental to achieving this. Pharmacy teams do a lot of goodwill and a lot of goodwill as business as usual.
What advice would you give to pharmacists who wish to pursue a career in mental health pharmacy?
Go for it. It is a rewarding and fulfilling career. It will provide you with an opportunity to have a very positive impact on the lives of your service users/patients and their carers. You will be presented with new and interesting challenges each day, but you will face them with the support of your colleagues around you. You will learn and grow as you practice both in terms of skills and knowledge and as a person. There are also plenty of opportunities and support for further professional development and you will feel and be supported.
Have you completed any additional qualifications in the area of mental health?
As well as a postgraduate diploma in pharmacy practice I also have a postgraduate diploma in psychiatric pharmacy. I am currently undertaking a PhD which is focused on mental health.
Could you describe a typical working day for you?
That’s a difficult question to answer as currently my time is split equally between clinical practice and research. Currently, on a practice day, I am responsible for leading on a service which is focused on improving the physical health for those with severe mental illness – ensuring monitoring is done and followed up. On a research day, this might be anything from undertaking a qualitative interview with a participant recruited to my research study, reviewing data collected, networking with others, reading, reviewing or research governance or conferences.
Are you a member of any professional bodies? Which ones and why are you a member?
I am also a fully credentialed member of the College of Mental Health Pharmacy
What is credentialing and why does it matter?
Credentialing is the College of Mental Health Pharmacy’s process for assessing members’ knowledge and experience. It allows a member to demonstrate that they are experts in the field of mental health pharmacy. (It does allow me to put the following letters after my name MCMHP). This type of membership is available to pharmacists and pharmacy technicians who have attained an expert level of working.
To be eligible for full membership the associate CMHP member pharmacist has to demonstrate their expertise. To this end here are certain criteria related to years of practice within psychiatric/mental health pharmacy and/or relevant qualifications. Further information can be found here for those who might be interested: here.
I had to demonstrate my expert level of practice by submitting a portfolio of evidence and sitting a viva.
What are the big issues that concern you at the moment in mental health pharmacy?
Effective utilisation of our knowledge and skillset to improve care for mental health within a rapidly changing NHS on the background of increasing calls for pharmacists to be involved. In my opinion key to this is the maintenance of core services but increasing time spent in patient-facing medicines optimization roles and as part of the multidisciplinary team.
What are the risks of pharmacists taking on more responsibility in the area of mental health pharmacy?
We need to ensure that the fundamentals of our role are understood to ourselves and others as far as is possible. This will avoid the threat to these fundamentals when we move forward and undertake new roles and activities. In addition, avoiding our role being seen as a gap-fill where there is a lack of resource in other areas but establishing and demonstrating what we can do well and what we know.
We are faced with the environment of increasing public expectations, workforce pressures, and advances in technology and medicine. Without this clarity, we will not be able to select, educate and train pharmacists or focus on what the workforce might look like going forward.
We must be clear that we do not lose our way or lose our identity. If we aren’t clear about our own professional roles and the boundaries of those roles this can lead to friction and the best interest of our patients/service users and the public might not be met. We must also make sure that in order for us to fulfil our potential we must work in harmony across disciplines (i.e. with doctors, nurses and other healthcare professionals).
Are you optimistic about the future of pharmacy in the UK?
Yes as long as we become more visible and provide more patient-facing and multidisciplinary care that is in the location convenient to those two key stakeholder groups. The main focus would be towards medicines optimisation for those on multiple drugs those with long term conditions, public health and provision of services for minor ailments. I am yet to fully understand the impact of primary care networks on primary care pharmacists so cannot really comment on this recent development.
What’s next for you?
I am currently in the throes of the third year of my PhD research and developing a whole new set of skills and understanding. Not only is this challenging but very exciting and it is really testing my resilience. I want to fulfil my responsibility to the participants who have given their time and effort to provide their data for my research. In addition to attain a level of writing that both I and my supervisory team are proud of I want to do justice for the core of the research – address the inequality that exists for those with mental ill-health.
I have a very general idea of where I might see myself going – hopefully in some sort of clinical academic role. I don’t have a master plan. I just want to continue to enjoy what I am doing and allow serendipity to have its hand in my future career.