Psychiatric Pharmacy Manifesto

College of Psychiatric and Neurologic Pharmacists Position Statement: Psychiatric Pharmacy Manifesto

All individuals receiving pharmacotherapy for a mental illness should be fully educated about their disorder and their drug therapy, and have appropriate expectations of their treatment.  Clinicians who treat these individuals should ensure that therapeutic outcomes are maximized, and adverse effects are minimized and appropriately managed.  For over 40 years, some pharmacists have specialized in providing pharmaceutical care to individuals receiving psychotherapeutic medication.  As a member of an interprofessional treatment team, the psychiatric pharmacist focuses on optimizing drug treatment by monitoring clinical response, recognizing and managing drug-induced problems, recommending appropriate treatment plans, ensuring that baseline and follow-up laboratory tests and physical assessments pertinent to drug therapy are ordered and utilized, and counseling the patient and family members about their medication. 

OUR UNIFIED APPROACH THROUGH LEADERSHIP AND ORGANIZATION

In 1992, the Board of Pharmacy Specialties recognized Psychiatric Pharmacy as a specialty of pharmacy; as of 2011, there are 627 board-certified psychiatric pharmacists (BCPP).  In 1998, the College of Psychiatric and Neurologic Pharmacists (CPNP) was founded, growing to a membership in 2011 of 1,130.

CPNP is committed to securing the future of psychiatric pharmacy by developing and strengthening the community of psychiatric pharmacy practitioners, developing psychiatric pharmacy services, and supporting legislation and regulations that promote increased pharmacist roles in providing direct patient care.

CPNP is committed to continually providing patients and families with education about their diseases and treatment.  CPNP has a close relationship with the National Alliance on Mental Illness (NAMI) to provide medication education to consumers.  Currently, CPNP members author information sheets regarding psychotherapeutic medication (www.nami.org). In addition, CPNP members answer patient medication questions in a series called “Ask the Psychiatric Pharmacist.”

Psychiatry is one of the most rapidly evolving disciplines in medicine. Its scientific foundation is neuroscience, and pharmacologic treatments for psychiatric and neurologic disorders are growing at the most explosive pace in science. Psychiatric pharmacists are directly involved in the psychiatric treatment teams, providing direct patient care and active medication education of patients and their families.  Yet the public and many health care providers still view pharmacists as primarily dispensing medication. For these reasons, CPNP proposes that a psychiatric pharmacy manifesto be created that promulgates the basic tenets of psychiatric pharmacy and make it a permanent, living document on the CPNP website.  The basic tenets of psychiatric pharmacy are detailed below.

OUR COMMITMENT TO PATIENT CARE

Psychiatric pharmacists provide compassionate, respectful, confidential, cautious, and responsible care

Psychiatric pharmacists provide patient-centered care, taking all aspects of the person into consideration when recommending medication use

Psychiatric pharmacists are uniquely positioned to prevent medication errors and enhance medication outcomes, promoting appropriate, evidence-based, and measurement-based medication use

The psychiatric pharmacist is uniquely trained in the pharmacology, pharmacokinetics, pharmacodynamics, and pharmacogenomics of psychotherapeutic medication, knowing when and how to apply this information to optimize patient care

Psychiatric pharmacists are proficient in the use of all medications, not just psychotherapeutic medication

Psychiatric pharmacists evaluate prescription, non-prescription, herbal products, vitamins, nicotine, alcohol, caffeine, and illicit substances for effects and interactions

Psychiatric pharmacists provide care for individuals with primary and co-morbid substance use disorders

Psychotherapeutic medication for serious and persistent mental illnesses requires continuous monitoring to achieve and sustain optimal response 

Psychotherapeutic medication is often well tolerated by people with serious and persistent mental illnesses, but adverse effects and/or drug interactions are common and require constant vigilance

Psychiatric pharmacists are the most appropriate practitioners to provide medication education to individuals with mental illnesses

Psychiatric pharmacists encourage the participation of families for optimal treatment outcomes

OUR DEDICATION TO THE MENTAL HEALTH CARE SYSTEM

All individuals requiring psychotherapeutic medication for a mental illness will benefit by being seen by a psychiatric pharmacist

Psychiatric pharmacists can provide needed patient care services in an over-burdened mental health care system.  The public mental health system is broken.  Seriously mentally ill individuals are stigmatized and impoverished, lack primary medical care, die decades earlier than the life expectancy of the general population, often abuse alcohol and illicit drugs, and are incarcerated in such huge numbers that jails and prisons have become the new mental “institutions.”

Psychiatric pharmacists can contribute to improved pharmacoeconomic outcomes by the use of evidence-based medicine

Psychiatric pharmacists provide a unique value to individuals with mental illness, to their families, and the health care systems serving them

Psychiatric pharmacists are uniquely qualified to educate other mental health care professionals about psychotherapeutic medication

OUR VISION FOR THE FUTURE

The future is bright because psychiatric pharmacists provide a unique perspective and contribution to the mental health care team

Psychiatric pharmacists’ abilities are not well recognized and are underutilized

The public needs to be educated about the value of a psychiatric pharmacist

More psychiatric pharmacists are needed to care for individuals with mental illness

Psychiatric pharmacists should be included specifically in future mental health initiatives by federal, state, local and commercial interests

Psychiatric pharmacists deserve recognition and payment for the clinical services that they provide

Psychiatric pharmacists must contribute to advancing pharmacy practice in general, and psychiatric pharmacy specifically, including participating in the development of the next generation of psychiatric pharmacists

Psychiatric pharmacists, whether academic or practice-based, must contribute to increased understanding of mental illness and psychotherapeutic medication by all pharmacy students and residents

Psychiatric pharmacists need to work with community pharmacists to assure appropriate care for people with mental illness in their community

In keeping with the scientific and health care tradition of communicating new ideas, psychiatric pharmacists should share their successful practice models with the larger community

Pharmacists are and should continue to be actively involved in conducting research to advance the evidence for appropriate use of psychotherapeutic medication

Mental health care initiatives are needed to extend the reach of psychiatric pharmacists to the millions of individuals with mental illness

Compiled and written by Glen L. Stimmel, PharmD, BCPP and the CPNP Past Presidents Council
July 6, 2011