The career path to become President of the College of Mental Health Pharmacy

Ciara Ni Dhubhlaing, Specialist mental health pharmacist, President of the College of Mental Health Pharmacy

 

Why did you become a pharmacist?

 

I have wanted to be a pharmacist since I started thinking about career options at around age 15. I’m not sure what influenced me really, but I enjoyed science and I wanted to be involved in direct patient care. Medicine wasn’t for me – too many negatives with the duration of the study and working hours and too much ‘icky stuff’!

 

Could you describe your career pathway so far?

 

I was offered a place on the Pharmacy course at Aston University but deferred it for a year to do first-year Science at Trinity College Dublin. Here I got to learn more about physics (which I hadn’t studied in school) and thoroughly enjoy fresher life without the worry of exams at the end. Studying at Aston ignited my interest in mental health and my preregistration year, split between City Hospital in Birmingham and Murray’s Pharmacies, a small independent chain in Cumbria, cemented it. It is an area in which clinicians have the opportunity to really engage with and think about the patient as an individual and what treatment would suit their needs best rather than which slot they fit into in a guideline. Working in palliative care was plan B for the same reason.

 

I initially worked as a relief pharmacist in community whilst completing the Aston Certificate in Psychiatric Pharmacy before obtaining a mental health post in Morecambe Bay Primary Care Trust (later Lancashire Care Trust) in 2004. There I was able to work on hospital wards including Acute Assessment Units for Adult, Elderly, and Dementia patients, a PICU, a Forensic Low Secure Unit, an Alcohol Detoxification Unit, and a Tier 4 CAMHS unit. I also worked with Supported Housing, Adult and Elderly CMHTs, CRHT, AOT and EIS Teams. Whilst in Cumbria/Lancashire I attended College of Mental Health Pharmacy (CMHP) Psych 1 and 2, completed my Postgraduate Diploma, and obtained my non-medical prescribing qualification.

 

On my route back home to Dublin, I took a minor detour into physical health working on a respiratory ward in Derry for nine months. It was a great boost to my confidence to realise my skills as a pharmacist were universal and I could still be useful on a physical health ward. Some people think working in MH is disheartening, but I found it more difficult to deal with the comparatively frequent deaths from lung cancer, pulmonary embolisms, cystic fibrosis, infections etc. that occurred on the respiratory ward.  In October of that year I finally returned home to work in St John of Gods and then St Patrick’s University Hospital. Both are private not for profit mental health hospitals which is quite a change from the NHS. It was a big adjustment to leave the NHS and come to a fragmented health service with multiple providers and tiers of service, no defined role for pharmacists within MDTs, and no pharmacist non-medical prescribing. However, a big advantage has been knowing what works in practice and being able to apply that to develop future services.

 

I obtained full credentialled membership of the CMHP in 2013 which is still my proudest achievement, though presenting my MSc research at the CMHP Conference in 2015 is a close second.

 

Could you describe a typical working day for you?

 

In my day job, I am Chief Pharmacist in St Patrick’s University Hospital in Dublin. This is Ireland’s largest, independent, not-for-profit mental health service with just over 300 inpatient beds and several outpatient centres. I manage a total of 18 staff members, including part-time staff and vacant posts, and we have a dispensary on-site.

 

I typically start the day following up on emails and voicemails and checking what has been prescribed for my patients on our ePrescribing system (RiO) overnight. I have learned that it’s best I have minimal verbal interaction with people first thing in the mornings as I’m definitely an owl not a lark. I may have to rearrange the rota if there is sick-leave and advise clinical pharmacists if there is a change to the wards they are covering. We work in a shared office so communication is straightforward.

 

Once any urgent medication is ordered, I will then go to the ward(s) I’m covering to see if any additional items are required and I will see new admissions for medicines reconciliation.

 

I often have a meeting around 11am (e.g. the clinical governance committee, drug and therapeutics committee, or falls committee) and if there is time after that I will try to speak to any patients I didn’t see earlier to complete medicine reconciliation. Occasionally I will take my morning tea-break and catch up with what is happening in my work-colleagues lives.

 

We close for an hour for lunch and I try to get out for some fresh air if it isn’t raining. That doesn’t happen too often in Ireland though.

 

After lunch I see what changes have been made to medications, follow up on queries and/or prescribing errors with the doctors, and spend an hour or two working on management tasks, staffing, policies/SOPs etc. Most often, those couple of hours fall from 4.30pm onwards. CMHP work gets done after 5pm too but I don’t mind that as I’m at my most alert in the evenings and it means I miss the traffic going home at rush-hour.

 

Pilates, meals with friends, and time spent with family help me to relax in the evenings so that I’m ready for the next day at work.

 

Are you a member of any professional bodies? Which ones and why are you a member?

 

I joined the College of Mental Health Pharmacy (CMHP) in 2005 and was Co-opted onto the CMHP Council in October 2014. I have since been elected and held the posts of Assistant Registrar, Registrar and Vice- President. I am currently the President. I’m still getting used to that. It’s hard to comprehend as I recall the high esteem with which I held Council members and longstanding CMHP (and formerly UKPPG) members’ knowledge and expertise. Imposter syndrome affects most of us to some degree, but I’m driven to carry on the legacy of those who have done outstanding work before me.

 

I joined the Executive Committee of the Hospital Pharmacy Association of Ireland (HPAI) in Feb.’16. I wanted to ensure the voices of pharmacists working in mental health were heard, and I wanted to get to know more of my peers in the Republic of Ireland. Working with Chief Pharmacists and colleagues through this Committee has given me the confidence to advance my career and access to experienced colleagues to seek advice from where necessary.

 

What is credentialing and why does it matter?

 

Credentialing with the CMHP is a huge achievement as it is recognition of your expertise from a panel of your peers. Having held the posts of Assistant Registrar and Registrar for the College, I know what an undertaking the assessments are and how seriously the assessors view them. Putting together a portfolio of evidence of expertise and sitting a viva ensures we have a comprehensive picture of the applicant’s knowledge and skills, so having the honour of using the post-nominals MCMHP is an important validation.

 

What are the big issues that concern you at the moment in mental health pharmacy?

 

We talk a lot about stigma in society but an issue I have only become aware of in the last few years is the stigma of mental health amongst healthcare professionals. I have experience of a colleague whose wards were not covered whilst she was on maternity leave as no-one wanted to cover the mental health wards, and I have had a conversation with a highly experienced pharmacist who had no problem seeing a patient for warfarin counselling but was very apprehensive about lithium counselling. Add to this that the most frequent question asked when we do talks to community pharmacists is “how do I talk to someone with mental health problems?” and I do think we have a real problem with awareness and understanding of mental health. (The answer is “just the same as any other one of your patients”, in case you were wondering!)

 

With more pharmacists moving into primary care, many have identified a need to improve their knowledge in the area of mental health and the CMHP is working with CPPE, MORPh and others to provide opportunities for education, but it would be great if undergraduate training was going further to meet that need sooner.

 

What are the risks of pharmacists taking on more responsibility in the area of mental health pharmacy?

 

Pharmacists have significant expertise in assessing risks and benefits of various scenarios. I think the majority will recognise their limitations and the areas in which they can add value. However, there are some people who lack a degree of self-awareness and/or may present themselves as having expertise which may not be valid. Use of non-protected titles such as Consultant Pharmacist should not be encouraged except for those who have followed the recognised pathways to obtain such titles to ensure that only experienced Pharmacists have responsibilities appropriate to their level of expertise.

 

Are there any particular traits or skills that pharmacists who specialise in mental health need?

 

Empathy and compassion are essential, although people must also learn self-care and how to protect their own mental health. Flexibility backed up by a knowledge of what the boundaries of guidelines are (and why) usually results in good patient outcomes.

 

What contribution in caring for people with mental health issues would you expect from a community pharmacist?

 

Community Pharmacists are tremendously important to patients with mental health issues. I am always delighted when completing medicines reconciliation if my inpatients tell me to ring the pharmacy and ask for their pharmacist by name. There is a lot of trust there in the health professional they often have the most contact with.

 

Do you think suicide prevention techniques should be taught to community pharmacists?

 

Yes, definitely.

 

Mental health first aid should be seen on a par with basic life support courses, and more widespread uptake may also reduce stigma. There is a wonderful suicide prevention taxi service in Ireland (taxiwatch.ie) where drivers learn how to bring up and discuss suicide with passengers whom they may identify as vulnerable – it’s nothing magical, just talking and signposting, but it can be just the right thing at the right time to change someone’s path. Similarly, the Foyle Search and Rescue Services in Derry have set up patrols to make contact with and provide another way for those in distress who may be contemplating suicide. These are not healthcare professionals, but their work is making a big difference. Imagine what a community pharmacist could do with their knowledge and skills!

 

What has been your proudest moment so far as a pharmacist?

 

Becoming a Credentialed member of the CMHP!

 

As a profession how should we reward pharmacists for outstanding practice?

 

I would like to see more consultant pharmacist posts being funded with clear requirements and a recognised pathway that identifies outstanding practice.

 

One of the best things about the CMHP is that it is a forum for sharing best practice and therefore improving standards of practice internationally. We celebrate such good practice with our poster and oral presentation awards at our Annual Conference and we are now publishing the award-winning abstracts in the Online Journal of Psychopharmacology for wider dissemination. Recognition of work being done is good for individuals and for the profession as a whole.

 

Are you optimistic about the future of pharmacy in the UK?

 

This is difficult to answer as a Europhile. On a day to day level pharmacists will continue to provide skilled care and expert medicines management but there are certainly challenges ahead with medicines shortages due to global drug supply issues and Brexit; the increased power of politicians to change the structure and function of the NHS; and the ever-increasing demands of the health service. I have no doubt, however, that pharmacists will always do the best they can for their patients no matter the circumstances.

 

What’s next for you?

 

I’m going to have my hands full for the next few years developing my department as Chief Pharmacist and being President of the CMHP. I have plans to introduce an admissions pharmacist role – something which is new in mental health in Ireland and I will be looking at opportunities to maximise the impact of clinical pharmacists through limited prescribing roles. We will be surveying CMHP members early in the new year and taking direction from them as to the future development of the College so, no doubt, that will generate some interesting and engaging workstreams over the next few years.

 

What advice would you give to pharmacists who wish to pursue a career in mental health pharmacy?

 

Go for it!

 

If you’re interested, you’re more than halfway there. Mental health pharmacy isn’t for everyone. There is ambiguity, legitimate treatments that may be outside the guidelines, and patients’ behaviour may sometimes vary more than with other health conditions. But, if your pedantic pharmacist nature can accommodate that and maintain empathy for your patient whilst keeping their best interest at heart, you will thrive.

 

Ciara Ni Dhubhlaing MPharm, MSc, MPSI, MCMHP. is Chief I Pharmacist at St. Patrick’s University Hospital, James’ St., Dublin 8. She is also the President of the College of Mental Health Pharmacy (CMHP)

 

If you would like to find out more about the College of Mental Health Pharmacy or would like to join click here. 

Mental health pharmacy is all about the person and their story

Wendy Ackroyd Mental Health Pharmacist

 

Wendy Ackroyd is the lead pharmacist at the mental health directorate in NHS Dumfries and Galloway. We were delighted to welcome her to share her experiences working as a pharmacist working in the area of mental health.

 

 

Why did you become a pharmacist?

 

The brutally honest truth?

 

I’m a failed medic, kind of.

 

I was about 4 years old when I decided I wanted to be a doctor. No one in my family had ever been to university so this was quite the ambition. My parents always encouraged me to believe in myself. So that’s what I was going to do, and I worked hard.

 

Having always been studious and quite well behaved I became a teenager all of a sudden at about age 16. I got a part-time job and a boyfriend. At that time I took my eye off the goal. I messed up my A levels and withdrew from PCAS in a fit of a teenage strop after a fall out with my parents. My school careers advisors didn’t even know what Pharmacy was. I didn’t know what to do and just gave up a bit. I was just going to get a job.

 

My form teacher suggested I applied to a pharmacy for a job to stay in a “medical like” field instead. And I did. The local Boots was looking for a trainee dispenser. I passed my Society of Apothecary’s dispensing technician course, and loved training counter assistants and talking to patients. I was told by many pharmacists I worked with that I could easily manage a pharmacy course. And by this time I had a better idea of what it was, so I applied. Most universities wouldn’t touch me with my A level results, but Sunderland took my dispensing qualification into account and gave me a chance.

 

I loved it.

 

Could you describe your career pathway so far?

 

In short falling in at the deep end. Thankfully I can swim. My first manager was a dispenser not a pharmacist, pretty much the only one in Boots back then. I was the only full-timer in the pharmacy department three months into my dispensing training, so was effectively running the department at that point.

 

My first job once qualified as a pharmacist was in a very busy Boots store in Cleveleys. My technician left a week after I started (not my fault). We did about 450 items a day.

 

I did relief management in the Lakes region of Boots for a couple of years after that and, frankly, I love patients. I have all the time in the world for them. I don’t like customers much. The shopkeeping part just wasn’t for me and I craved a clinical role. So I took a huge pay cut and a B grade job in Westcumberland Hospital with a 1 in 3 on-call from where I lived – 45 miles away – to get some hospital experience. I loved the hospital role but I couldn’t afford to stay at a B grade for more than a year. It was an £8k difference in salary back then 20 years ago.

 

So I asked about locally (within 60 miles) to see what was available. I was invited to “come for a chat” at Dumfries hospital pharmacy department. I had said chat with Mike Pratt and was then offered a job, temporary D grade in mental health. Their usual guy was in New Zealand on sabbatical. HR was not quite as involved in recruitment back then. I thought “why not?” and took it.

 

He saw me coming, or he saw potential, who knows? I had never heard of the Crichton Royal Hospital and it wasn’t mentioned at all in our “chat”. Westcumberland mental health wards were in the infirmary itself. I thought that’s how it worked everywhere. So was somewhat surprised to be handed a passkey and told to go look after “The Crichton”. No induction. No mental health background. And this was a victorian psychiatric hospital with 11 wards left in it, mid-transformation, in a different Trust and nobody could tell me what I was actually supposed to do. I was the only pharmacist for mental health of any kind in the entire region. It was a steep learning curve.

 

I had a six-month temporary contract. That was in January 2000. I loved it. I still do.

 

Don’t get me wrong it has almost broken me once or twice. But I love working in mental health. I love the challenge and the patients I work with and I am happy, even proud, to be a voice for what is still a Cinderella service, although it’s improved a lot in 20 years. We now have 2 pharmacists and recently added a part-time addictions post; I am expending our empire bit by bit.

 

You have an interest in mental health pharmacy. Why?

 

It’s more than an interest, it’s a passion. What is more fascinating than the mind? How fragile it can be in some, and yet how robust in others. We can all break mentally under the right, or wrong, circumstances. One in three could be affected in their lifetime. And yet it’s poorly studied, funded and supported. I’ve always been a sucker for the underdog. Mental health and wellbeing are multifactorial, it’s hard to measure, and treatments are complex and evidence isn’t always especially robust. Pharmacists are often quite black and white. We like details and guidelines and protocols. It’s about how we’re trained.

 

In my spare time, I’m an amateur artist, I think that creativity spills into my work. Once the evidence runs out the question remains  “what can we do for people that makes some sense to try – and how can we keep them safe at the same time?” It’s all about the person and their story at the centre of it all.

 

Every day is different. There are puzzles to solve and problems to fix. It is endlessly fascinating and challenging at the same time. It’s a huge jigsaw puzzle with medication forming a teeny tiny part of all that, but an important piece, and a potentially toxic one if you mess it up. Medicines can’t fix everything but they can have a huge impact on someone’s ability to cope with life.

 

Have you completed any additional qualifications in the area of mental health?

 

My postgraduate education route was a bit messy. I was in the first cohort of community pharmacists offered the postgraduate certificate in community clinical pharmacy. I then changed to a hospital diploma and overlapped that with the Aston certificate in psychiatric therapeutics, before finishing my MSc in clinical pharmacy. I did a study on satisfaction with medicines information in mental health. I’m a pharmacist independent prescriber too, but used CVD and diabetes as mental health wasn’t offered at Strathclyde.

 

My development was very much shaped by the College of Mental Health Pharmacy (CHMP). Their email group for answering questions and absorbing discussions and the conference was a great opportunity for learning. It was a lifeline for someone like me early on with no mental health background, and working in an isolated position. I even did a stint on Council and as Secretary for CMHP a wee while back. We have a group Scottish Pharmacists in Mental Health, for educational activities too, and did my part on the committee for that a few years back too.

 

Could you describe a typical working day for you?

 

Not really, no. No such thing. And honestly, I like it that way. There are elements of the week that happens, like ward rounds, and my dispensary duty, but each day is so varied. I’m pharmacy lead for mental health directorate which also includes psychology, substance misuse, and the local prison. This is quite a remit. We have an 80 bedded hospital, 4 CMHNTs and geography of 150 miles by about 60 miles for a population of 150k.

 

I’ll give you an idea with what’s on my desk just now:

 

  • This week I’ve been involved in my very first interviewing for the addictions pharmacist. That was exciting but quite stressful.
  • I’m trying to set up a mental health prescribing subgroup (again) as our new Director of Pharmacy is bringing things up to date.
  • Our national contract for Clozapine has changed and I managed the switch for that. I had some paperwork to organise to ensure all teams know what’s going on.
  • I’ve answered a variety of clinical questions today on treatment options for a few outpatients and in the infirmary.
  • I’ve had dispensary duty in the infirmary this morning for a couple of hours.
  • I’ve had an email discussion about managing pharmacist independent prescribers in substance misuse and the appropriate way to direct funding for the medicines prescribed that service.
  • I’m considering how we might introduce esketamine if and when it gets its licence.
  • I have ADTC this week and have papers to go through for that. Our ADTC is regional so it’s not just mental health. I also sit on our exceptional prescribing panel.
  • I had to find info on haloperidol drops to liquid/tablet conversion for someone just here from Poland.
  • I’m involved in the, almost completed, review of our alcohol detoxification pathway to ensure it goes through the various governance hoops to go forward for approval.
  • I’m trying to figure out how to improve mental health knowledge and confidence in talking to people with mental health problems for the new general practice clinical pharmacists (GPCP). Thinking also how that fits with our new GP based psychiatric nurses and how we get them all working together.
  • I’m looking at developing or buying in some joint training but as a first step I want some “talking about suicidal thoughts” input for the GPCPs so I had a meeting about getting that going.
  • I need to arrange a 1:1 and review with my junior pharmacist. She’s on holiday just now so I’ve also been clinically checking pass prescriptions.

 

Are you a member of any professional bodies? Which ones and why are you a member?

 

I am a supporter and member of Royal Pharmaceutical Society (RPS). I think they do a lot of great work to support pharmacy as a profession and get us seats at tables we wouldn’t always be on. I am an associate member of College of Mental Health Pharmacy. My performance and development plan this year includes credentialing and accreditation for next year. To be honest it’s about time I got on with it. I’m a member because of the education and support they offer in my specialist field. Once I was a newbie needing support and advice, now I have the opportunity to give some of that back at times.

 

What is credentialing and why does it matter?

 

Credentialing is about proving you are working at a certain level. The RPS offers to credential at different levels of practice in general. CMHP offers advanced level but just in mental health. To complete CMHP accreditation is to show I’m a specialist in my field. I’ve considered both RPS and CMHP. I am a staunch supporter of CMHP and I feel it fits me best, and my Director of Pharmacy is in agreement.

 

I guess we all have that feeling that we’re going to be “found out”, maybe we’re not that great after all – “Imposter Syndrome” it’s been described as. In many ways, I don’t need to prove to my colleagues that I’m good at what I do. They already appreciate what I bring to the table. For me, it’s about proving it to me, about challenging myself and a little bit of masochism perhaps. If I’m honest I’m apprehensive about it but it’s the same for everyone I’m told. It’s also a huge CPD opportunity. If I do find out that I need to improve it’s a way of identifying that. That can only be good for the patients I care for because if I need to do better I will because I owe them that.

 

Everyone’s reasons for credentialing may be different. Maybe it’s about getting a specific job. Maybe it’s about challenging yourself. Maybe it’s about learning and reflection. You reflect and decide what it is to you.

 

What are the big issues that concern you at the moment in mental health pharmacy?

 

There isn’t enough of me to do everything, that’s always been an issue. I need to find creative ways to support and develop mental health knowledge and confidence in managing mental health conditions in a wider audience of pharmacists. Primary care, addictions and acute liaison are areas I’d like to target. We’re making progress bit by bit. I like the jigsaw analogy. I need more pieces of the jigsaw fitted together. A small health board has many challenges but working together creatively is something our pharmacy team is especially good at doing.

 

The government document Achieving Excellence in Pharmaceutical Care gives us a direction to work towards. Although it doesn’t specifically mention mental health it is entirely applicable to anyone with mental or physical health needs.

 

Stigma is still a problem. And I feel we could do more to protect the mental health and wellbeing of those that work in healthcare. Austerity and staff cuts take their toll on those of us working in the system and we need to be mindful of that.

 

What are the risks of pharmacists taking on more responsibility in the area of mental health pharmacy?

 

I don’t think the risks are greater for mental health necessarily than for any other area of health. Our role is expanding, possibly down to fewer doctors qualifying creating gaps.

 

We need good governance, across the board to ensure we work appropriately and within our competence. We also need appropriate multidisciplinary skill mix so we have the right people working where their skills and knowledge best meets the needs of our patients. We need to ensure we don’t just absorb the work of other staff groups to stick a plaster over a gaping wound. It is important that we put things in place to improve services for patients and manage risks without losing what makes us unique, our expertise in medicines.

 

We need to look at risk differently and some of that is down to how our governing body behaves. Doctors accept risk in what they do, pharmacists try to avoid it. But of the two we’re the only ones who can go to jail for making a genuine mistake. If we want pharmacists to work in broader roles and the risks that come with that, we need to fix that disparity.

 

I think we need to stop thinking of mental health as a separate being and think holistically, and think broader than medicines. Mental and physical health and wellbeing are broader than drugs. It’s also about diet, exercise, smoking, stress, meaningful activity and our social circumstances. Loneliness, family support and many, many other things. Pharmacists have a talent for being able to see the whole individual with regards their treatments, but we need to look broader than the medication.

 

I went to a public health event a year or so ago when they told us. Mental health patients die on average 20 years sooner than the general population. Like that’s a new thing. That’s not news; I knew two decades ago. What is sad is that the wider audience were surprised by that and that in two decades we haven’t affected it. This is what holistic, patient centred care is about. Not silo-based care fixed around a service or profession but looking at all the needs of the individual and how best to meet them in a way that fits that person.

 

Are there any particular traits or skills that pharmacists who specialise in mental health need?

 

Be compassionate, non-judgemental but boundaried. Negotiate and educate, don’t dictate. See the whole person and their lifestyle and how that impacts on them. Listen. Be open-minded. Be aware of and educate yourself on the illnesses and the treatments. Motivational interviewing techniques wouldn’t go amiss. Be creative if necessary. People don’t always fit in boxes, neither does how they manage.

 

And be aware of your own triggers. Many pharmacists will also have mental health difficulties. Look after yourself too. I’m not sure any of these are specific to mental health though.

 

What contribution to caring for people with mental health issues would you expect from a community pharmacist?

 

The same as they’d have in caring for anyone else. Community pharmacists are the most involved in anyone with a medium or long term condition. They see them more often than a psychiatrist anyway. Ask people how they’re getting on and listen. Be able to give advice on what to do about side effects, or if someone wants to come off their treatment help them weigh the pros and cons. Know where other services are if you need to signpost. Know how to contact someone if you have concerns.

 

Do you think suicide prevention techniques should be taught to community pharmacists?

 

Absolutely. And everyone else. Just like we should all learn CPR. In some ways working in mental health is about having confidence and compassion, to want to have difficult conversations and know how to deal with them.

 

It is not someone with a mental health problem in front of us. It’s a person.

 

People get thoughts of suicide. They don’t need a mental health diagnosis for that. Asking someone if they have those thoughts does not make them more likely to die by suicide. People have them or not. You can’t make someone suicidal by asking them about their thoughts. But you need to have some idea how to respond appropriately if they say they do. Asking and responding to the situation could give that person the pause that changes their mind.

 

What has been your proudest moment so far as a pharmacist?

 

I was walking my dog a couple of years back and I bumped into another dog walker and got chatting, as you do. He said he expected I didn’t recognise him (and I didn’t) but he’d been at a meeting I was at when his daughter was an inpatient in our mental health hospital.

 

He said I’d said something to her that had really helped her and it made a huge difference to how she felt. I’d helped her understand what the medicines could do for her but also was honest about what they couldn’t do, and as a consequence, she decided to start taking them and they made a huge difference to her. At the time of this conversation with her Dad, she was well and planning her wedding.

 

We all have days when we wonder if we really achieve anything, but knowing I made a difference to that one person makes it all worth it. We don’t often set the world on fire as pharmacists, and may not always see the impact we have but something small, said with honesty, compassion and confidence can make a huge difference to that one person.

 

As a profession how should we reward pharmacists for outstanding practice?

 

I know a lot of pharmacists who like gin. Perhaps not in keeping with health lifestyle advice though. I don’t know, we’re awful as a profession for blowing our trumpets. I think that harkens back to what I’ve said before. A mix of imposter syndrome and not recognising the impact we can make. Most of us don’t do it for rewards or recognition. Acknowledgement at least challenges us to feel better on the days we wonder what we do it for, and boosts us to keep doing better. It makes us feel like we matter.

 

Are you optimistic about the future of pharmacy in the UK?

 

Yes, absolutely, we’re taking over the world. Pharmacists have lots of skills and we are adept at finding solutions to gaps in services, to adapting to different environments and bringing something unique and meaningful.

 

What’s next for you?

 

Short term – I’ve been writing this for ages. I think I’ll eat, take a walk, maybe do some painting; that’s how I look after my mental health and wellbeing. I’m trying to develop my oil painting skills.

 

Professionally – CMHP accreditation next year (eek!) and then probably some leadership stuff after that. We’re working as a team on how we can meet Achieving Excellence in Dumfries and Galloway. I’ve got a new addictions pharmacist starting soon to get up and running. I’d like to see if we can develop a liaison psychiatry pharmacist role here. Developing primary care skills, knowledge and confidence in mental health management is on my list too.

 

Longer-term I’ve got a yearning for a role in patient advocacy, perhaps in the Mental Welfare Commission. They don’t currently employ a mental health pharmacist, but I think they should.

 

What advice would you give to pharmacists who wish to pursue a career in mental health pharmacy?

 

All pharmacy involves mental health pharmacy, but if you want to specialise or just want a taste of what specialist mental health is, speak to your local specialist pharmacist, join CMHP, and get on with it. I love it.

 

 

 

Career spotlight: Dolly Sud on her role as a mental health pharmacist

Dolly Sud Mental Health Pharmacist

 

Why did you become a pharmacist?

 

During my childhood whenever I visited friends and family in a hospital who weren’t well or when I went to the pharmacy which wasn’t far from our house I was struck by how very well respected the pharmacist was as part of the healthcare team. I also noticed how well they worked alongside other healthcare professionals and had so much expertise and knowledge about medicines. I was impressed by how much they helped people take care of themselves and manage their medication. Later on, at school, I developed a keen interest and ability in chemistry which propelled my interest further. That all sounds very idealistic and viewed through rose-coloured glasses but I was very young.

 

Could you describe your career pathway so far?

 

On the face of it, I think if someone was to read my CV they might think that my “pathway” has been planned or strategically thought through. This is not the case. On balance I would say I have made the very best use of opportunities that I have come across or have been presented serendipitously. I have been very lucky to have a wonderful range of experiences and a variety of jobs in different healthcare settings and with many different teams. In addition, I have also been lucky to been provided with opportunities to undertake postgraduate qualifications which have been funded in terms of money, time and support from the pharmacy departments and managers with whom I have worked.

 

I have had roles in primary care, secondary care and at the interface in both general medicine and mental health/psychiatry. In addition, I have been exposed to opportunities to lead on innovative service developments and be autonomous in making decisions on initiating and pushing projects forward. In fact, my career to date has been split approximately equally between general medicine and mental health/psychiatry and my postgraduate diplomas also reflect this. I am at the point now where I am embarking on the next steps and adventures in my career undertaking research as part of a PhD with Aston University whilst continuing clinical practice.

 

You have an interest in mental health pharmacy. Why?

 

If I might I would like to rephrase this if I may? I would say I have always had an interest in mental health, mental ill-health and the treatment and care of mental health. The main reason from this, if I am honest, stems from my personal experience of witnessing first-hand the impact of (untreated) mental illnesses from a very young age. Since I started practising as a pharmacist I have felt the call to work in mental health. I was lucky to be provided with an opportunity to work at a mental health trust around 11 years ago and since then I haven’t looked back. I feel that I should use my expertise, knowledge and understanding of medicines and how they work as well as my personal experience in a positive way to improve care. (Hope that doesn’t sound like I am trying to be too heroic)

 

One key factor that I would say that has been pivotal in my current role is that I currently work in a department that is led by a fantastic management team and I have been supported and pushed to improve my work. The people I work with across my NHS trust are wonderful and I have been privileged to have formed some good professional relationships which have blossomed.  In addition, I feel that I have had many doors opened to allow me to fulfil my ambitions and aspirations as well as do things that I had never thought of before.

 

Are there any particular traits or skills that pharmacists who specialise in mental health need?

 

They are no different from the traits or skills that I would expect from a pharmacist working in any other area of patient-facing healthcare setting. I would say that mental health pharmacists compared to other pharmacists may over time develop a greater degree of emotional resilience, compassion and empathy as a consequence of the particular challenges faced within psychiatry. Other skills that are honed during practice, that facilitate a better quality of interaction with service users, their carers and the rest of the team, include perception and sensitivity as well as being able to reason both inductively and deductively. My subjective experience is that I have used and applied my pharmacological knowledge more in psychiatry than in any other setting that I have worked in.

 

What contribution to caring for people with mental health issues would you expect from a community pharmacist?

 

Community pharmacists are the most frequently visited healthcare professional in the UK. They have a role to play in asking someone how they are having to provide a point of contact where someone feels comfortable to ask for advice. In addition, community pharmacists often come in to contact with community psychiatric nurses, who visit the pharmacy with service users, their carers on their behalf. As such community pharmacists can be the first link to pick up on the fact that a service user might have stopped taking their medication or is acting out of character. Community pharmacists can provide advice on side effects and their management as well as encouraging adherence.

 

Interestingly I am exploring this as part of my PhD research. We are exploring the role of pharmacy in physical health in mental health. It is vital that we get the views of community pharmacists and technicians on the role of pharmacy in supporting the physical health of individuals with severe mental illness (e.g. schizophrenia).  If you would like to know more about my PhD research project and/or be involved please have a look at our webpage.

 

CARDIOPHITNESS research study

 

Do you think suicide prevention techniques should be taught to community pharmacists?

 

You should have a look at work from Hayley Gorton (Senior Lecturer in Pharmacy Practice, University of Huddersfield) – she is the expert on this. Hayley’s PhD was about the pharmacoepidemiology of suicide and self-harm. From this work, there was reflection on what community pharmacy teams can do to raise awareness and help prevent suicide and self-harm.

 

In my opinion, yes, absolutely. Community pharmacists are the most frequently visited healthcare professional in the UK. Patients often choose to visit a particular pharmacy regularly for many years and have a trusted therapeutic relationship with the pharmacy team and the pharmacist. The position of the pharmacy team within the community means that they may be able to identify changes in medical, social and personal factors as well as the wellbeing of their patients. Pharmacy support staff may enhance this as the first point of contact in the community pharmacy where the pharmacist might not be the same person every day. The opportunity exists to signpost to national support groups or local services.

 

Red flags such as excessive quantities or frequency of over the counter medication could be picked up by the community pharmacy team. In doing so this could prevent poisoning by accident or suicide. Straightforward interventions of reminding of the maximum doses of, for example, paracetamol could be effective. In addition, pharmacist identification of medication implicated in overdose during a clinical check would be very valuable and trigger additional counselling of the patient and their carer and discussion with the prescriber if necessary. Counselling of patients who have been started on antidepressants is another important role that should not be overlooked – there is a need to emphasise time take to get the full benefit as well as the increased suicidality that may occur.

 

I would also include pharmacists who work in A&E as they might encounter individuals who have taken overdoses and they may be involved in post-discharge care. Pharmacists who work in GP practices might have a role with regards to reducing risk where smaller quantities of medication are prescribed by the GP to reduce risk. All pharmacists can be involved in recommending medication which has lower toxicity in overdose.

 

What has been your proudest moment so far as a pharmacist?

 

I was able to sit down with a service user and discuss different antipsychotic drug choices and discuss the pros and cons of each. After this discussion, the service user was able to make an informed decision about which one might be the most suitable and this was discussed with the multi-disciplinary team in the ward round. I was able to follow this up and the service user has been adherent to the medication since that discussion took place.

 

As a profession how should we reward pharmacists for outstanding practice?

 

Highlighting and reporting achievements and good practice in-house, locally, nationally and internationally– but not restrict this dissemination to pharmacy world only – share across disciplines.

 

Increase investment in training and opportunities

 

A lot of this lies fundamentally in individuals and teams reporting or having opportunity and platforms to report on the outstanding practice. As well as recognising that it is outstanding in the first place – I think traditionally pharmacy hasn’t always been good at “blowing its own trumpet”. So instilling this early on in pharmacy training is fundamental to achieving this. Pharmacy teams do a lot of goodwill and a lot of goodwill as business as usual.

 

 

 

What advice would you give to pharmacists who wish to pursue a career in mental health pharmacy?

 

Go for it. It is a rewarding and fulfilling career. It will provide you with an opportunity to have a very positive impact on the lives of your service users/patients and their carers. You will be presented with new and interesting challenges each day, but you will face them with the support of your colleagues around you. You will learn and grow as you practice both in terms of skills and knowledge and as a person.  There are also plenty of opportunities and support for further professional development and you will feel and be supported.

 

Have you completed any additional qualifications in the area of mental health?

 

As well as a postgraduate diploma in pharmacy practice I also have a postgraduate diploma in psychiatric pharmacy. I am currently undertaking a PhD which is focused on mental health.

 

Could you describe a typical working day for you?

 

That’s a difficult question to answer as currently my time is split equally between clinical practice and research. Currently, on a practice day, I am responsible for leading on a service which is focused on improving the physical health for those with severe mental illness – ensuring monitoring is done and followed up. On a research day, this might be anything from undertaking a qualitative interview with a participant recruited to my research study, reviewing data collected, networking with others, reading, reviewing or research governance or conferences.

 

Are you a member of any professional bodies? Which ones and why are you a member?

 

GPhC (obviously!)

 

I am also a fully credentialed member of the College of Mental Health Pharmacy

 

What is credentialing and why does it matter?

 

In short….

 

Credentialing is the College of Mental Health Pharmacy’s process for assessing members’ knowledge and experience. It allows a member to demonstrate that they are experts in the field of mental health pharmacy. (It does allow me to put the following letters after my name MCMHP). This type of membership is available to pharmacists and pharmacy technicians who have attained an expert level of working.

 

To be eligible for full membership the associate CMHP member pharmacist has to demonstrate their expertise. To this end here are certain criteria related to years of practice within psychiatric/mental health pharmacy and/or relevant qualifications. Further information can be found here for those who might be interested: here.

 

I had to demonstrate my expert level of practice by submitting a portfolio of evidence and sitting a viva.

 

What are the big issues that concern you at the moment in mental health pharmacy?

 

Effective utilisation of our knowledge and skillset to improve care for mental health within a rapidly changing NHS on the background of increasing calls for pharmacists to be involved. In my opinion key to this is the maintenance of core services but increasing time spent in patient-facing medicines optimization roles and as part of the multidisciplinary team.

 

What are the risks of pharmacists taking on more responsibility in the area of mental health pharmacy?

 

We need to ensure that the fundamentals of our role are understood to ourselves and others as far as is possible. This will avoid the threat to these fundamentals when we move forward and undertake new roles and activities. In addition, avoiding our role being seen as a gap-fill where there is a lack of resource in other areas but establishing and demonstrating what we can do well and what we know.

 

We are faced with the environment of increasing public expectations, workforce pressures, and advances in technology and medicine. Without this clarity, we will not be able to select, educate and train pharmacists or focus on what the workforce might look like going forward.

 

We must be clear that we do not lose our way or lose our identity. If we aren’t clear about our own professional roles and the boundaries of those roles this can lead to friction and the best interest of our patients/service users and the public might not be met. We must also make sure that in order for us to fulfil our potential we must work in harmony across disciplines (i.e. with doctors, nurses and other healthcare professionals).

 

Are you optimistic about the future of pharmacy in the UK?

 

Yes as long as we become more visible and provide more patient-facing and multidisciplinary care that is in the location convenient to those two key stakeholder groups. The main focus would be towards medicines optimisation for those on multiple drugs those with long term conditions, public health and provision of services for minor ailments. I am yet to fully understand the impact of primary care networks on primary care pharmacists so cannot really comment on this recent development.

 

What’s next for you?

 

I am currently in the throes of the third year of my PhD research and developing a whole new set of skills and understanding. Not only is this challenging but very exciting and it is really testing my resilience. I want to fulfil my responsibility to the participants who have given their time and effort to provide their data for my research. In addition to attain a level of writing that both I and my supervisory team are proud of I want to do justice for the core of the research – address the inequality that exists for those with mental ill-health.

 

I have a very general idea of where I might see myself going – hopefully in some sort of clinical academic role. I don’t have a master plan. I just want to continue to enjoy what I am doing and allow serendipity to have its hand in my future career.