After a year of preparatory work, the College of Mental Health Pharmacists was launched on October 6 at the annual conference of the UK Psychiatric Pharmacy Group. This article explains the college’s origins and aspirations
Information on the numbers and on the work of pharmacists in mental health
is scarce. In 1997, 229 secondary care centres (mostly hospitals) were identified
as having pharmacists dedicated to mental health. In addition, all community
pharmacists deal perhaps daily with mental health issues, but it is not known
how many of them have a special interest in mental health or regard themselves
as specialist. The United Kingdom Psychiatric Pharmacy Group has around 400
active members, of whom the great majority work in secondary care. These pharmacists
are thought to provide a wide range of standards and breadth of service. Many
work essentially alone in small specialist departments. Some are isolated in
larger departments in general hospitals; only a few work in large, supportive
specialist departments.
One prime objective of the UKPPG is to support mental health pharmacists working
in isolation or without adequate peer or management backing. This has partly
been achieved through the provision of an annual conference and through various
levels of residential training. The UKPPG has also supported more formal postgraduate
specialist education, initially through the diploma and MSc in psychiatric therapeutics
at De Montfort university and, more recently, through the certificate and diploma
programmes in psychiatric pharmacy at Aston.
These initiatives have clearly helped to develop the practice of at least some
pharmacists working in mental health. However, two major deficits were apparent.
First, attendance at conferences and postgraduate training opportunities were
only available to a minority of pharmacists, perhaps, ironically, those who
were already well supported at their place of work. Second, there remained no
practicable method of assuring the quality of practice of pharmacists in mental
health. Coincidental with the realisation of these shortfalls was the introduction
of clinical governance in the National Health Service. Clinical governance demands
professional peer review, life-long learning and assurance of best practice
— exactly those factors identified as deficits of the extant system.
The need for a college
Pharmacists are health care practitioners whose ultimate objective is to ensure
the optimal use of medicines. Mental health is no different in this respect,
but no body existed to ensure that pharmacists were adequately trained and performing
to the standards necessary to ensure optimal medicines use. The UKPPG therefore
put forward the idea of a college which would ensure competence through an accreditation
scheme that supported pharmacists’ development through to formally recognised
specialist status. Thus, the new college was viewed as an essentially facilitative
body which could ultimately ensure the optimal use of medicines in mental health
— an aim wholly in accordance with the essence of clinical governance.
Consultation
The UKPPG committee agreed in early 1999 to work towards establishing a college
of mental health pharmacists. Members were then invited to comment on the proposals.
A great many comments were received and it was realised that the proposals were
too detailed for this early stage of development. As a consequence, relatively
broader proposals were put forward as motions for the UKPPG annual general meeting.
Well over 100 members attended the meeting and a large majority voted in favour
of the establishment of a college and a formal election of college founder to
carry this out. Founders were tasked with setting up a facilitative accreditation
scheme which would accredit at least 25 specialists within two years.
Before the AGM, less formal consultation had taken place with the Department
of Health, the Royal College of Psychiatrists, mental health charities and a
number of hospital pharmacy managers and regional representatives. All had broadly
supported the initiatives outlined, albeit with reservations from some hospital
pharmacy managers.
Election of founders
In late 1999 the UKPPG committee invited applications from pharmacists wishing
to be considered as college founders. Ten applied and produced biographies outlining
their academic and practical experiences, their achievements, and their views
on the new college and its potential. A free postal election then took place
with a large majority of members voting. Members were advised to vote for those
pharmacists who could best represent mental health pharmacists in the NHS. The
five elected founders represented a wide spectrum of experience: two are chief
pharmacists with academic backgrounds, two are senior pharmacists with extensive
and broad clinical experience, and the fifth is a self-employed pharmacist with
experience in hospital, community and research.
Progress to date
Initially with the assistance of the UKPPG committee, the college founders have
elected a president, vice-president, secretary and registrar, treasurer and
public relations officer, and established a constitution for the college. An
accreditation scheme has been developed, sent out to all UKPPG members for comment
and refined in response to advice received. This scheme provides substantial
support to pharmacists wanting to progress to specialist status. This is achieved
through the availability of postgraduate training and the early allocation of
mentors to help applicants achieve the required breadth and standard of practice.
Founders have also established a work programme designed to ensure the accreditation
of the first 25 specialists and work has begun on the clear definition of competence
required for specialist status. A specialist in education is involved in this
latter process.
The future
Initially, the College of Mental Health Pharmacists has a mandate only to establish
a system of specialist accreditation which allows 25 pharmacists to be awarded
specialist status. It is hoped that trusts providing services to mental health
will consider it prudent to have at least one accredited specialist pharmacist
in their employ who can then be responsible for pharmaceutical care under the
requirements of clinical governance. Further consultation with the Department
of Health is, therefore, necessary and the college will need to establish some
credibility with trust chief pharmacists and chief executives and to inform
these same people about the aims of the college. Eventually, the college may
fund and conduct research and organise or facilitate postgraduate training.
Conclusion
The College of Mental Health Pharmacists has been established by the UKPPG with
the aim of ensuring optimal use of medicines in mental health and is recognised
as a good example of delivering professional competence. It is, ultimately,
patient-centred in that all of its functions are intended to improve the care
of people with mental illness. It is hoped that, in striving towards this goal,
pharmacists will be supported, encouraged and helped to develop into specialist
practitioners with the necessary skills and knowledge to ensure optimal treatment.
The new college should be welcomed as a prescient example of the need properly
to take responsibility for the drug-treatment of mental illness.
The authors are founder members of the College of Mental Health Pharmacists. Further information is available from Dr Taylor, chief pharmacist at the Maudsley Hospital, London SE5 (e-mail David.Taylor@slam-tr.nhs.uk) and at www.ukppg.org/cmhp.html