PRISM Psychiatric Diseases

Acute mental health care costs in Connecticut are substantial. In 2013, hospitalizations for mental illnesses resulted in some 32,000 discharges and 260,000 in-patient days. Further, between 2009 and 2013 there were 1 million emergency department admissions related to mental illness and substance abuse. Fortunately, community pharmacists in Connecticut who are interested in participating in the mental health care needs of their patients are beginning to be identified. A recent example of this is Dr. Charles Caley’s efforts to train qualified community pharmacists to administer long-acting injectable antipsychotics (LAIAs) to patients with schizophrenia. Through a unique collaboration with the state’s division of drug control and Genoa-QoL, the School of Pharmacy has started the development of a strategic network of community based pharmacies who can administer these important treatments for which patients and providers do not have sufficient access. The goal of developing this state-wide network will be to strengthen access and reduce re-hospitalization rates for patients. Once this network has been developed further, administration of other long-acting dose forms for the mental health/substance abuse patient populations will be explored.

Dr. Nathaniel Rickles, as both a board-certified psychiatric pharmacist and social scientist, has and continues to explore the impact of new roles by community pharmacists in caring for those with mental illness.  He started such work many years ago evaluating a pharmacist-guided telephone education and monitoring intervention by community pharmacists.  This work provided important findings that highlighted how community pharmacists can have a significant impact on knowledge, beliefs, and other perceptions of care.  His work has also explored the factors affecting community pharmacists willingness to engage in services with those with mental illness.  Dr. Rickles found stigma of mental illness and pharmacist’s orientation to counsel were two significant predictors of pharmacist willingness to provide services to those with mental illnesses. This latter work led to the development of a pilot study exploring a consumer-led intervention to reduce pharmacist stigma of mental illness.  Results are encouraging to suggest a brief consumer-led intervention can facilitate pharmacist attitude changes toward those with mental illness.

Publications in this area include:

Calogero S, Caley CF. Supporting patients with mental illness: deconstructing barriers to community pharmacist access. J Am Pharm Assoc 2017 57(2): 248–55. DOI: 10.1016/j.japh.2016.12.066.

Goren JL, Rose AJ, Engle RL, Smith E, Christopher M, Rickles N, Semla T, McCullough MB. Organizational characteristics of high- and low-clozapine utilization clinics in the Veterans Health Administration. Psychiatr Serv. 2016 Jun 15:appips201500506.

Rickles NM, DaCosta A.  A consumer-led intervention to improve pharmacists’ attitudes toward mental illness. Mental Health Clinician [Internet]2016;6(2):95-100. DOI:10.9740/mhc.2016.03.95.

Rickles NM, Dube GL, McCarter A, Olshan JS.  Relationship between attitudes toward mental illness and the provision of pharmacy services. Journal of the American Pharmacists Association. 2010;50:704-713.

Rickles NM, Svarstad BL, Statz-Paynter J, Taylor LV, Kobak K. Improving patient feedback about and outcomes with antidepressant treatment: a study in eight community pharmacies. Journal of the American Pharmacists Association 2006;46:25-32.

Rickles NM, Svarstad BL, Statz-Paynter J, Taylor LV, Kobak K. Pharmacists’ telemonitoring of antidepressant use: effects on patient feedback and other outcomes.  Journal of the American Pharmacists Association 2005;45: 344-353.

Funded grant projects in this area include:

Tailoring Patient Options for Medication Adherence Action Plans in Community Pharmacies. Sponsor: Patient-Centered Outcomes Research Institute ($40,000 from May 2015 to present); Project Co-leaders: Nathaniel Rickles and David Johnson.