For Mental Health Awareness month, Pharmacy Times interviewed Kishen Patel, PharmD, CSP, BCMTMS, clinical pharmacist at Shields Health Solutions, about his role in the mental health space. He discusses how he addresses concerns with adverse events, potential drug-drug interactions, medication management, and the strategies that are used to offset the potential complications. Further, Patel stresses the importance of advocating for yourself, friends, family, caregivers, and patients, not just this Mental Health Awareness Month, but every day.
About the Expert
Dr. Kishen Patel, PharmD, CSP, BCMTMS has been a clinical pharmacist at Shields Health Solutions since 2018. Dr. Patel is a Certified Specialty Pharmacist (CSP) and a Board-Certified Medication Therapy Management Specialist (BCMTMS). In his role at Shields, he reviews newly prescribed medications with patients and collaborates closely with their health care providers. He is also passionate about mental health, working to advocate for others and help continue the conversation to “break the stigma.”
Dr. Kishen Patel has been practicing pharmacy since graduating with his PharmD from Massachusetts College of Pharmacy and Health Sciences in 2015.
Pharmacy Times: Can you provide an overview of what you do as a clinical pharmacist who specializes in mental health?
Kishen Patel: So, as a clinical pharmacist, I try to look at the patient as a whole, from their medications to their different comorbidities that include their mental health. I look at the patient's medication list, I check for drug-drug interactions, but I also check for the liver [and] kidney function and confirm that all their prescribed medications are appropriate. I often see drug interactions with newly prescribed medications and I communicate with the providers about these potential drug-drug interactions to come to a resolution. More often than not, the prescribers are not aware of any newly prescribed medications by other providers, or even aware of the patient's full medication list. So it's my role to help bridge that gap in the patient's care and recommend adjustments if needed.
Pharmacy Times: What are common mental health conditions that you encounter in your practice, and what treatments do you often prescribe to manage these conditions?
Patel: So, I primarily work and specialize with our oncology clinic, but there are multiple different conditions that put patients at high risk for mental health challenges that include autoimmune disease, HIV, multiple sclerosis, but really mental health challenges can come with any diagnosis, no matter how serious. One of the most challenging times for a patient is when they receive their diagnosis. They immediately inherit a burden of paperwork, new medications, additional responsibility, and they need the support and care, otherwise, they may fall behind and experience unexpected adverse events (AE s) fall behind treatment, which may lead to faster progression of their condition.
One of the most common mental health conditions that I see in my practice are either depression [or] anxiety, which is completely reasonable with these patient populations. How my team typically works is when a patient is prescribed a new—let's say oncology medication—we review the medication for therapeutic appropriateness, we review the new medication with the patient, go over AEs, mitigation strategies, how to take the medication, missed dose protocol, but I also ask about their well-being too, because mental health is just as important as our physical health. It is vital to review any new medication with a patient because it can provide them a sense of comfort when starting a newly prescribed medicine [and] give them some peace of mind. With our practice, the patient will never feel rushed, they are allowed to ask all the appropriate questions—however big or small—in order to have their needs met. They are newly diagnosed with their condition, and it can be life-altering. The important aspect I've learned over the years as a pharmacist, is to provide them a safe space where they do not feel like a burden, [and] they feel heard [and] their thoughts and feelings are validated, because it is real to them at this time.
Pharmacy Times: How do you address concerns about potential AEs associated with the medications you prescribe, and what steps do you take to offset these?
Patel: The AE profile can be sometimes difficult to distinguish, especially when a patient is starting multiple different medications at once. When speaking with a patient that's experiencing an AE, I try to address [it] by providing maybe some mitigation strategies that I alluded to earlier. Sometimes with the more severe AEs that we may see—especially with psychotropic medications—we may see them become more agitated. So, some tips that I like to recommend—or at least, try to utilize—is verbal de-escalation, trying to work on mindfulness, and if the patient is willing, maybe work on meditation. There are some instances though, where a patient while speaking with them may show symptoms of self harm, and I can do a few different options. I can refer them to, let's say the 988 number, which is the Suicide Crisis Line, where a person can call, text, or chat with someone when they're struggling, and they are able to have their feelings shared with someone. In a particular instance, though, if needed, I can keep a patient on the phone and I can have a colleague reach out to, let's say, the local police department for a wellness check to ensure the patient's safety.
Those are the more rare or severe AEs we may see, but more typical AEs may include...diarrhea, constipation, nausea, and I like to recommend over the counter items. For example, [loperimide] (Imodium; McNeil Pharmaceutical) for diarrhea, or stool softeners for constipation, [as well as] crackers, ginger ale, and bread for nausea, just to help the patient be able to tolerate the medication a little bit better. But it's also our duty as pharmacists to inform the provider depending on the severity of the AEs too.
What I also learned is, in order to help patients succeed on therapy, we need to start setting expectations with their medications. It's reasonable to have a patient expect their medication to make them feel immediately better. But let's say, for example, a patient who's starting on an SSRI for depression, that often takes about a few weeks—2 to 4 weeks or so—to see improvement in their symptoms. So, I'll try to give the patient a timeline to set their expectations but also let them know when they should call the doctor for certain situations. There are times where patients will speak with us more than their providers and we have an opportunity to learn more about our patients day-to-day lives, and provide them better patient care and continue to be their advocate throughout their treatment journey.
Pharmacy Times: What is the potential role of medication management either with therapy or other non-pharmacological interventions when treating mental health disorders?
Patel: Medication management is vital and key to any patient's success. We often see patients who are not sure why they're on a certain medication, and sometimes it's a case where the medication is no longer medically necessary, or even the patient may not even be taking their medication as prescribed. All of which can lead to increased risk for AEs or...so with every patient interaction that I have, I tried to complete a medication reconciliation that includes the medication name, the dose, the frequency and the indication. If there's any discrepancies, then I tried to resolve them with a patient and/or provider to confirm the patient is continuing to receive optimal care. With respect to treating mental health disorders, patients often forget or even unaware of the resources the hospital systems can provide, for example, therapists, social workers, transportation, food access...patients sometimes feel overwhelmed with their diagnosis that they do not remember these resources are available for them. When I bring up these resources, I do not push them to see, let's say for example, a therapist, I may encourage it, but [I] let them know [that] if they're interested and want to see someone, then the option is available for them, and I often can help facilitate the referrals for these patients who are interested.
Pharmacy Times: How do you stay up to date with the latest developments in the mental health space, and how are you incorporating these methods into your practice?
Patel: Staying up to date with the latest developments is a passion of mine, and there are multiple different avenues that I try to utilize. So, for example, working with 1 of my employee resource group, EMPOWER, helps provide me a safe space to express my voice, [while] also staying informed on any new recommendations. But for me, the best way for me to learn and help my patients is to simply just listen to them and by showing compassion and empathy to make them feel comfortable. There are those who find reading, meditation, therapy, [or] distraction has helped them and I will listen to them tell me about these tools that they utilize. I note this because, if I can take one patient's experience and use this to help another, it may be something out of the box for that patient [but it] can help lessen the mental stress of the individual.
Pharmacy Times: Can you discuss any exciting developments (eg, clinical trials, new treatments) in the mental health space that you are either excited for or interested in?
Patel: So, the mental health realm is always evolving, and what I'm most certainly excited about is how much we as a society are becoming more open with one another. Every voice has the right to be heard, and as we talk and listen more, we continue to fight the stigma behind sharing one's feelings and discussing mental health. We have come so far in the past 10 years, yet we have so much further to go [and] we can continue to grow and expand and share because no one deserves to suffer alone. And my goal, [in] the end, is to be an advocate for someone who may lose their voice, but I will always continue to and try to give them at platform they deserve.
Pharmacy Times: May is Mental Health Awareness month. How are you celebrating, and what do you think others should do for their mental health?
Patel: I guess 1 of the main things I like to do is just talk, ask someone how they're doing, [and] take care of one another. Because there are people who may be strong on the outside but may be struggling on the inside. It's okay to check on your friends, family, and colleagues. Also, along with patient care, we have to worry about the caregiver burden, too, and we often forget about it.
If I had to give 1 piece of advice, [it would be to] always talk, always communicate, and try to be an advocate for yourself and for someone who you love. I did see this quote the other day that I just wanted to leave you with: "Mental health is not a destination but a process. It's about how you drive, not where you're going."
