Improve counseling of patients with mental health conditions

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The relationship between patients with mental health conditions and community pharmacists may be disappointing, according to a 2012 survey developed through a collaboration between the College of Psychiatric and Neurologic Pharmacists Foundation and the National Alliance on Mental Illness (NAMI). In the survey, 75% of respondents reported they did not receive effectiveness or safety monitoring assistance from their pharmacist. In addition, 43% of patients taking mental health medications said they did not have a strong professional relationship with their pharmacist.

The primary concern of this patient population was the lack of privacy in the pharmacy to perform consultations, so pharmacists should address that first. Strategies aimed at increasing privacy can include consulting patients during nonpeak or slower time periods or scheduling telephone consultations during times preferred by patients. Pharmacists could also designate a private consultation area within the pharmacy.

Some positive findings from the survey were that 91% of patients taking mental health medications felt very comfortable going to community pharmacies and 83% reported feeling respected by their pharmacist. Therefore, given the right environment, pharmacists can make a positive impact on patients with mental health disorders by engaging and educating them on safe and effective medication use.

Key points

When educating patients with mental health conditions, pharmacists should inform patients when they should expect the medications to begin working and discuss off-label use of medications to treat their conditions.

Many mental health drugs do not work immediately, so pharmacists can tell patients that these agents may take weeks before they cause noticeable improvements in mood. In addition, inform patients that long-term therapy may be required to help prevent the return of symptoms.

One type of drug used off-label that pharmacists may have to counsel patients about is antiepileptic agents used as mood stabilizers. Patients receiving these agents for mood stabilization may be alarmed if they read materials describing a drug to treat epilepsy. Pharmacists should inform patients if they are prescribed medications for off-label use to avoid confusion.

Pharmacists should also educate patients never to stop taking their medications abruptly, as withdrawal symptoms may occur. Tell patients not to change the dose of their medications without talking to their health care provider first. Review the importance of avoiding interacting agents such as alcohol or other central nervous system depressants, and discuss both serious and more common adverse events.

If patients have questions about FDA safety alerts, explain the communications clearly and discuss how they affect individual patients. Many mental health medications have an FDA-required Medication Guide that should be given to patients at the time of dispensing. These documents are written specifically for patients and may be a good starting point for a discussion about the safe and effective use of medications. These guides are available online.

Educate patients inquiring about herbal or dietary supplements marketed for various mental health conditions about their efficacy and safety. Many of these products have not been tested in well-designed trials, are no more effective than placebo, and may interact with prescription medications. Tell patients not to take these products until they have discussed it with their provider.

Resources to explore

If patients seek additional information, refer them to online materials available through NAMI or the National Institute for Mental Health (NIMH). NIMH has developed a patients’ guide, available online, explaining the various classes of drugs used to treat mental health conditions, including their adverse effects, directions for use, and FDA warnings.

The National Council for Patient Education (NCPIE) has developed a list of questions for patients asking about the effectiveness and safety of medications.

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