Page 81 - Retail Pharmacy Magazine October 2020

Greg Murray, Professor of Psychology at Swinburne University, tells Retail Pharmacy that mental disorders have varying degrees of severity, but that their influence is far reaching on patients and families concerned. “Pharmacists are in a prime position to engage and support people with mental health problems, because they can just drop in without an appointment,” he said. “The stigma of mental health issues drops away here because people go to see pharmacists for many reasons, with mental health being just one of them. “Their role is also prime because doctors and psychiatrists who prescribe mental health medication often just don’t have the time to answer all the questions a patient may have. In fact, the GP or the psychiatrist may not even be able to help the person clarify what their questions are.” Framework for thinking about medication Professor Murray says it’s important that patients are prescribed a framework for thinking about their medication. “Questions that come to the fore,” he said, “are what type of medication is this, how does it compare with other medication, what are the possible interactions with other medications, what are the pros and cons of taking this medication, what’s the evidence for this medication, how common are its side effects, does everyone with bipolar disorder take lithium or do some people have mixed feelings about it? “Even a question-and-answer session wouldn’t be adequate. What’s required is an extended discussion.” Multiple medications Professor Murray says multiple medications accompany “serious” mental disorders, which is an area that the university focuses on. Patients with schizophrenia and other psychotic disorders, bipolar disorder and severe depression are typically on five, six, seven or eight medications, he says. “This medication regime is incredibly complex, with each part deserving discussion, as does the whole set,” he said. “This is because patients want to know that this medication is meant to do this, and this one’s meant to do this as well. “The problem is made more complex because, as symptoms change and life changes, prescribers change or tweak medications, meaning that patients literally lose track of what they’re on. This makes for an incredibly complex medical and behavioural task.” Pharmacists and the psychology of medication This is where pharmacists play a “very special role”, Professor Murray says, which includes asking questions about the medication patients are taking and how it’s affecting them. “The role includes some understanding of the psychology of medication,” he said. “For example, we know that a significant proportion of people with serious mental disorders really don’t like taking their medication – and that’s not an exaggeration. The reasons are partly medical, in that the medication is not as effective as it should be, or it comes with negative side effects, but a major reason is the daily reminder to a person of the things that are the worst in their life and most out of control. “So, morning medication comes with the reminder that they’re sick, and of the traumatic and negative experiences they’ve endured – that life has proven difficult for them to cope with.” Professor Murray says healthcare professionals can empathise here, as everyone can imagine how keen they would be for a family member with a serious mental disorder to feel empowered, confident and able to live a rich and full life. Therefore, he says, the psychology of taking medication is an important part of the discussion between a pharmacist and a patient with a mental health disorder. “This centres around what it means to take medication for a mental health disorder, and this is not the same thing as taking medication for something like blood pressure, because that’s not about the patient, but mental health disorder medication is all about the patient, their history and frailties,” Professor Murray said. “So we would love to have pharmacists have a holistic perspective on medication in these instances and the difficult experiences the patient has endured, because in the moment that they take their medications they’re not neutral and they have to deal with the medication’s efficacy, its side effects and the psychology around taking it. These are major issues. “This is where pharmacists can play a role as not just providers of information but also as supporters on the emotional side through asking open-ended questions such as what’s it like to take their medication, what’s their view on it, and the like.” MENTAL HEALTH 79 MENTAL HEALTH TRICKY AT BEST “Pharmacists are in a prime position to engage and support people with mental health problems, because they can just drop in without an appointment.” RETAIL PHARMACY • OCT 2020