Pharmacy professor cares for patients with mental illness

Provider Status Profile

Melissa Kelly was diagnosed with epilepsy when she was a child. Though she saw many physicians for the condition throughout her life, it wasn’t until she saw Sarah Melton, PharmD, BCPP, BCACP, CGP, FASCP, that she learned about her medication and its adverse effects.

Sarah Melton

“She told me things I never knew about seizure medicine—that it would make your bones brittle. I had to get all my teeth pulled, and I never knew that was because of the seizure medication,” Kelly said.

Kelly was originally referred to Melton for management of her medication for bipolar disorder. Melton, who is board certified in psychiatric pharmacy, sees patients with mental health conditions at Highpower, PC, in Lebanon, VA, and Johnson City Community Health Center in Tennessee. 

At the two multidisciplinary, team-based clinics, Melton helps relieve the burden on psychiatrists and psychiatric nurse practitioners, who can be backlogged over a year. But unlike these and other health care providers on her team, Melton, and other pharmacists in this series, cannot bill insurance commensurate with the level of care she provides. CMS does not recognize pharmacists as health care providers. 

University salary

Melton cares for patients at these two clinics as an Associate Professor of Pharmacy Practice at East Tennessee State University’s Gatton College of Pharmacy. As such, her university salary allows her to see patients in these clinics, where student pharmacists and other student health professionals get hands-on training.

In addition to adjusting Kelly’s bipolar medications until they worked for her, Melton put Kelly on calcium and vitamin D for her bones. She also referred her to a new neurologist. In the past, Kelly had seen physicians who suggested she was faking her seizures. Kelly was having three to five seizures a day and taking dozens of medications for them. Melton wanted her to see a neurologist who would take her seriously.

“If it hadn’t been for Sarah [Melton], I would not have gone to Dr. Shields. And I would not have gotten the vagus nerve stimulator,” Kelly said.

The intervention has reduced Kelly’s seizures from up to 5 per day to 30 in the last 2 years. She’s greatly reduced the number of medications she must take, and she reports less bone-related pain as a result of taking supplements.

Specialist in psychiatric pharmacy

As a specialist in psychiatric pharmacy, Melton addresses the high rates of nonadherence and undesirable medication adverse effects characteristic of her patient population. She cares for patients who are severely depressed, some who are contemplating suicide, and many who are battling addiction. As her patients are predominantly low-income, Melton also connects them with assistance programs that help cover the cost of medications. She refers them to other necessary resources and appropriate specialty care, as she did for Kelly.

Melton may work with patients in the intervening time until they can see a psychiatrist or psychiatric nurse practitioner, or her interventions may eliminate the need for a psychiatric visit all together.

“I have a counselor that works right there with me, so she’s able to do the psychotherapy while I do the medication management. Oftentimes the patients don’t even need to go to psychiatry after we’ve gotten them on appropriate medications and participating in counseling,” she said.

Valued team member

Melton’s team sees her as a colleague and valued team member. “We all just feel like we’re equally important parts of the team. I’m providing just as important a contribution as everyone else,” she said. “If I’m not here because I’m away teaching, they call me and say, ‘Where are you? We need your input.’”

But health insurance plans do not recognize pharmacists as an equal member of the team. If it weren’t for Melton’s university position, she most likely would not be able to provide the level of care that she does. But many more patients could benefit from a pharmacist’s care. Twenty-five percent of U.S. adults have a mental health condition, according to the Robert Wood Johnson Foundation. Colleges of pharmacy cannot employ enough pharmacists to care for all of these patients.

“If the reimbursement were appropriate for the work that we do, pharmacists would be able to do this on their own without juggling a full-time teaching job, too,” Melton said. “And we would be able to see more patients.”