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A Mind & Body approach to pharmaceutical healthcare

Siobhan geeSiobhan Gee, Psychiatric Liaison Pharmacist at King’s Health Partners, explains how taking a Mind & Body approach to pharmaceutical healthcare can greatly improve patient outcomes.

Being a Psychiatric Liaison Pharmacist has traditionally been a lonely pursuit. When I started back in 2010 at Guy’s and St Thomas’ NHS Foundation Trust, I was the only psychiatric pharmacist based in an acute hospital in the entire country. Happily, that’s no longer the case and there is now an increasing recognition of the importance of optimisation of pharmaceutical care for patients suffering with mental health disorders whilst they are physically unwell. I now work as a psychiatric liaison pharmacist at Guy’s and St Thomas’ and King’s College Hospital NHS Foundation Trusts, and do my best to support teams across the whole of our partnership.

At its core, my role is to provide clinical advice about psychotropic medication (drugs which treat psychiatric conditions) to psychiatrists, medical staff and pharmacists across King’s Health Partners. Not only is there a huge burden of mental health conditions amongst patients in acute hospitals, there is also a high proportion of patients who will be prescribed medicines to treat those conditions. The drugs we use to treat mental illnesses are often complicated in their own right, and that’s before adding in acute illness to complicate things further.  Not only is psychotropic medication use in patients with comorbid physical health problems a common and complex business, we also largely lack any clear guidelines to help with decision making in many circumstances.

This is where a psychiatric liaison pharmacist comes in. Prescribing complex medicines to patients safely and effectively requires the input of someone with specialist knowledge of the medicines, but it also needs someone with specialist knowledge of the ways in which those medicines can interact with the medical and psychiatric conditions.  

Dealing with clinical enquiries is a large part of my role, but I also contribute to the writing and audit of policies related to psychotropic medicines, including addictions (opiates, alcohol and other illicit substances) and potentially toxic drugs (lithium and clozapine).  Responding to the specific needs of the acute hospitals in this respect has been vital – I wrote the policy on the use of medicines in the care of acutely agitated patients at Guy’s and St Thomas’ NHS Foundation Trust more than six years ago now, and at the time it was the only guideline of its type in the UK; I’m pleased to know that that is no longer the case!

I have also been involved in many other innovative projects, including the Dementia and Delirium team at Guy’s and St Thomas’ NHS Foundation Trust, where I was able to support the clinicians in stopping harmful antipsychotic prescribing, and have just completed research looking at the impact of a mental health diagnosis on the likelihood of missing drug doses on acute wards in response to the Treat As One report.

All of this work requires continued collaboration and communication with the teams at each hospital, as well as an understanding of how all the electronic (and human!) systems work at all three trusts. This has been no mean feat, and I’m very excited that through the Mind & Body programme, we are now strengthening those links. Our next steps are to focus on greater collaborative working between the pharmacy departments at King’s Health Partners, making the most of the world-leading levels of expertise we have and using this to improve our care not only of patients with psychiatric illnesses at the acute hospital sites, but also our care of medically unwell patients admitted to South London and Maudsley NHS Foundation Trust.

My role as a psychiatric liaison pharmacist now feels a lot less lonely. The work going on at King’s Health Partners to collaboratively optimise medicines across the mental and physical divide shows just how much improvement in patient care can come from by sharing knowledge and expertise between our hospitals. We no longer need to institutionally separate mental health pharmacists from physical health pharmacists!