Healthcare professionals should work closely with pharmacists to optimise and monitor the use of psychotropic and other medicines prescribed for physical and mental conditions. This is one of several recommendations made in an intercollegiate report written by the Academy of Medical Royal Colleges and the royal colleges of general practitioners, nursing, pathologists and physicians, Public Health England and the Royal Pharmaceutical Society (RPS).
The report, ‘Improving the physical health of adults with severe mental illness: essential actions’, makes eight recommendations to healthcare bodies and inspectorates, from the creation of a new national steering group to lead and link stakeholders with experts from the professions, to improvements in healthcare training and IT infrastructure.
Currently, 46% of people with severe mental illness have a long-term physical health condition and are at risk of losing, on average, 10–20 years of their lifespan because of physical ill health. The report, which was launched on 25 October 2016, makes practical recommendations for changes that will help adults with severe mental illness receive the same standards of physical healthcare as the general population across the NHS. It defines severe mental illness as a diagnosis of schizophrenia, bipolar disorder or other psychotic disorder that causes significant disability and has lasted for at least two years.
“The ambition of this report is to provide a focused programme of actions that can be taken across the system, from training to leadership and best practice in care provision, to reduce preventable premature mortality in this vulnerable group,” says Dame Sue Bailey, chair of the Academy of Medical Royal Colleges.
The report covers several areas specifically relevant to pharmacists. It asks that when pharmacists are involved in the clinical care of patients with mental disorders they should be competent in several areas, including: being able to manage drug interactions that may compromise co-existing physical or psychiatric drug treatment; being able to recognise the adverse effects of physical illness and treatments that may result in the emergence of psychiatric symptoms; being able to optimise medicines use in the management of long-term conditions; being able to promote healthy living strategies, such as weight management, smoking cessation and oral health; and being able to use screening tools to identify physical health risks, such as the risk of falls.
Primarily, however, the report promotes pharmacists working within multidisciplinary teams to optimise medicines use for patients with severe mental illness to improve their overall health.
“We urgently need to see better integration of mental and physical health services, so that people are treated as a whole,” says David Branford, member of the RPS English Pharmacy Board. “The majority of premature deaths in people with severe mental illness are caused by potentially changeable health-risk behaviours.
“Targeted intervention to support people with mental health problems with smoking cessation, weight management, addiction, advice about physical activity and medicines optimisation are all necessary and can be delivered by pharmacists.”
The report suggests that all pharmacists should retain the competencies outlined in the RPS’s foundation and advanced practice frameworks. It also recommends that the College of Mental Health Pharmacy should review its accreditation standards to ensure pharmacists have adequate skills and knowledge regarding the management of physical conditions.
Electronic prescribing should become “the norm” throughout the NHS to ensure the seamless transfer of relevant clinical information, according to the report, but it highlights that to do this there needs to be national standards for the descriptions of drugs and dosages, standardisation of prescribing and integration between pharmacy and prescribing systems.