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Letters to the Editor
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Mental health
Time to reconsider mental health as a single specialty
From Mr J. P. M. Pratt, MRPharmS
It is disappointing that The Pharmaceutical Journal chose to print only
a brief mention of the National Institute for Clinical Excellence guidelines
on the short-term management of disturbed or violent behaviour (PJ, 26
February, p224). I would have expected that The Journal would have highlighted
at least some of the recommendations that were of particular relevance
to pharmacists or specialist pharmacists.
These guidelines provides us with comprehensive guidance on the range
of interventions that we should be using to manage disturbed or violent
behaviour. They do not deal with pharmacological treatments in isolation,
but do recognise the important role that specialist pharmacists have
as members of multidisciplinary teams using drugs to tranquillise people
rapidly. They even make an explicit recommendation that “specialist
mental health pharmacists should be members of multidisciplinary teams
where rapid tranquillisation is being used”.
Clearly there will be a need for organisations to reconsider the constitution
of multidisciplinary mental health teams to ensure the presence of a
specialist mental health pharmacist. This also raises questions about
where these pharmacists are going to come from and, perhaps more importantly,
what qualifies someone as “a specialist mental health pharmacist”.
The specialisation of pharmacists is becoming accepted as the norm but,
given the complexities and risks of medicines use, perhaps it is now
time to reconsider mental health as a single specialty. Many organisations
continue to employ pharmacists on the basis that they are expected to
be “the” mental health specialist covering populations of
several hundreds of thousands of people. Such an approach is almost tokenistic
to the idea of multidisciplinary involvement. It is impossible for one
person to be a member of all the multidisciplinary teams that use drug
treatments in mental health.
Although there will clearly be some time before adequate numbers of pharmacists
are available to join the majority of multidisciplinary mental health
teams, the planning for this needs to happen now. Both undergraduate
and postgraduate courses need to reflect that pharmacists will be expected
to practise as “specialists” and not generic “pharmacists”.
As a profession we need to help support pharmacists to choose their area
of specialisation. For those pharmacists who are unsure about whether
or not they would want to specialise in any aspects of mental health
we can still offer places on our “taster
programme”, which
has been funded through the national spread programme (see PJ, 20 November
2004, p749).
Peter Pratt
Chief Pharmacist, Sheffield Care Trust, and Chief Pharmacist,
Doncaster & South Humber NHS Trust
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The
Pharmaceutical Journal