Following the launch of the Scottish Government’s Mental Health Strategy 2017-2027 earlier this year, health and social care providers across the country have been reflecting upon how their services meet the needs of those with mental health conditions.
Community pharmacies are amongst the contractor groups who will also be considering how they can work with the NHS to make the necessary developments to achieve the strategy’s vision, where people can get the right help at the right time, expect recovery and fully enjoy their rights, free from discrimination and stigma.
To create a health and social care environment that reflects this vision will be no mean feat, with only an estimated one in three people who would benefit from treatment for a mental illness currently receiving it.
Figures like this suggest not only that some of the stigma attached to mental health conditions still lingers on in society, but also that NHS services are either difficult to access, lack capacity, are not promoted enough, or a combination of these three factors. However, it must also be acknowledged that many people who have mental health conditions do not seek help from ‘traditional’ mental health services, in itself a unique challenge which will require novel approaches .
With mental health services having moved, for the most part, over the last few decades from secondary care into the community, primary care practitioners have become increasingly involved in mental health care. This involves managing an established diagnosis with the patient and support workers or delivering unplanned, opportunistic interventions where necessary – just as is the case with physical health. These interventions are essential to encourage people to seek early treatment for emerging mental illness and can happen in any setting, including community pharmacies. However, there is currently no formal structure to this process for many healthcare providers, leading to differences in outcomes depending on local service design and each individual practitioner’s awareness of access arrangements in the area.
One potential solution to this is the development and roll-out of a distress brief intervention package to health and social care service providers. This tool is currently being evaluated, and if proven effective could be paired with improved referral pathways to embed a crucial mechanism for identifying mental illness in non-traditional settings, which will contribute to the strategy’s key themes of prevention and early intervention. With appropriate training, potentially devastating illness can be addressed opportunistically in the whole population, or can be targeted to priority groups such as those with substance misuse problems, those who experience loneliness or social isolation, pregnant women and women who have recently given birth, to name a few, all of whom often visit their community pharmacy regularly.
Once a diagnosis has been confirmed, treatment can be commenced – which can be for a short period of time or life-long, depending on the illness identified. Treatment often consists of regular therapy, dedicated support for issues stemming from or relating to mental health and may also include medication as a part of the holistic care of the individual. As experts in medicines, community pharmacists help people to get the very best out of their treatment, ensuring that each person can achieve what matters to them in their life by optimising therapies in partnership with medical colleagues and providing pharmaceutical care and self-management advice.
A recent pilot of structured care bundles to be administered alongside certain mental health medications can only improve consistency in this respect if proven effective. This advice and support is not only restricted to mental health conditions but also for physical considerations as well. This rounded support is especially important for those with mental health issues, as on average those with severe and enduring life-long diagnoses will have a life expectancy around 15-20 years shorter than those without, usually because of physical ill health. This can be for many reasons, including medication side-effects, weight gain, reduced likelihood to attend medical reviews and a considerably higher smoking rate than the general population. Again, health and social care providers who are in regular contact with these people are in a privileged position and should be supported fully to engage with and provide assistance to improve appropriate service uptake wherever possible.
Although our members are providing essential support (whether formal or not) for those with mental health problems across Scotland, we believe that so much more can be done to increase our contribution to the vision set out in the mental health strategy. This should include the roll-out of brief intervention tools and medication care bundles, but whilst these are in development we have chosen to take a proactive step by selecting the Scottish Association for Mental Health (SAMH) as Community Pharmacy Scotland’s charity partner for the next two years. This partnership will not only raise much-needed funds for the charity, but will increase awareness across our network of the third sector support and materials which are available for those in the communities which they serve.
Harry McQuillan is chief executive of Community Pharmacy Scotland.