Collaborative Care: Pharmacists Make a Difference in Mental Illness

Ms. Farley is a freelance medical writer based in Wakefield, Rhode Island.

More than a quarter ofadults in the UnitedStates suffer from adiagnosable mentalillness; in fact, 13% of the top 300most frequently prescribed medicationsare psychotropic medications.Health care providers, includingpharmacists, work tirelessly tohelp this patient population, whenit is possible that they will never seeresults.

Xuan Cung, PharmD

As pharmacist specialist at a busymental health facility, Xuan Cung,PharmD, adeptly manages these difficultcases. Her work is at the SantaClara Valley Health and HospitalSystem (SCVHHS) in San Jose, California,a county facility that sees18,000 mental health clients a year.Their emergency psychiatric service(EPS) sees 10,000 patients per year.Cung?s role as a medication expertcomes into play as these patientsmay present with both medical andmental illness.

After graduating from the Universityof the Pacific, Cung started atSCVHHS dispensing in an ambulatorypharmacy before getting intomanagement. Eventually she took ona clinical role in psychiatry. ?WhenI first graduated, I did not have aninterest and was not mentally readyto get into psychiatry.? After 10 years,she was ready for the challenge.

Day-to-day Efforts

Weekly group sessions allow Cung todiscuss medications and side effectsdirectly with her patients. She managestheir care indirectly through medicationmonitoring and consultation withthe other health care staff. When sheis not in the EPS or inpatient unit,Cung works regular hours catchingup on patient files, communicatingwith the medical staff on medicationreviews, and providing updates on thelatest medicationnews. Collaborationbetweenpharmacist,psychiatrist,and socialworker is avital part of treatingmentally illpatients, she says.

?In the process of educating patients,you have to listen and learnfrom your patients. These patientsare chronically mentally ill. Theyhave had the disease for longer thanI have been a pharmacist. It is almostan education for you, because theyhave had the disease for so long,? saysCung. ?You know the textbook version,and they live it,? she adds.

Challenges Faced

One of the biggest challenges andperhaps the biggest disappointmentsin this job is the high recidivism rate.SCVHHS? EPS has a 54% readmissionrate. ?In the younger population,there is higher recidivism. Manyare not compliant.? Cung says thatpatients stop taking their meds for avariety of reasons, such as cost andparanoia, which leads to relapse. ?Abig issue is polysubstance abuse. Anevent causes them to relapse intodrugs and alcohol.?

Besides these frustrating statistics,the environment can be a challenge.?The inpatient unit gets to be stressful.Patients can get violent. This iswhere the maturity comes in. Themore exposure you get to this patientpopulation, the better off you are,?advises Cung.

?You have to understand that itis not personal,? she explains. ?Youneed a tougher exterior. Mentally illpatients may get better in the hospital,but once they are out, they areback to the way they were. In otherareas of pharmacy, you see patientstake your advice and get better, butnot here.?

The Heart of the Matter

Ultimately, dosing, compliance, andside effects are the crux of Cung?swork. She says, ?The biggest challengeis that there are no lab testsavailable to gauge how patients aredoing. Dosages are adjusted based onqualitative assessments. We have onlythe interaction between provider andpatient. That is where the collaborationbecomes so important.

?This patient population is themost difficult to help due to the mentalillness, not the person. You mustbe able to differentiate that.?

She is quick to add, however, ?Thereward is that you are participatingin the chain of care that helpsthem get better and fully functional.This is not possible for all patients.Although you may not see that rightaway, know that the support you givehelps them achieve the quality of lifethat best suits them.?