Treating Serious Mental Illness (SMI) With Long-Acting Injectable Medications - Episode 10

Increasing Pharmacists Awareness of Mental Health

Troy Trygstad, PharmD, MBA, PhD; Tripp Logan, PharmD; and Carla Cobb, PharmD, BCPP, examine ways pharmacists can get more involved in managing mental health, including depression screenings and referrals to physicians, and also share some access issues to these patients when managing their mental health care.

Troy Trygstad, PharmD, MBA, PhD: If I’m an average-practicing pharmacist out there, what’s the first place I would start, from the perspective of a specialist such as yourself? I want to be more aware. I want to have more acumen in this space. Do I go to Google? Where do I go what do I do?

Tripp Logan, PharmD: I’ll tell you what we did. We just decided we were going to start doing depression screenings in the pharmacy, and we called around and asked who would like a referral. So, it was a really good way to get in the door somewhere. And we had several that said, “Yes, absolutely, we would like a referral.” And so, we did a national depression screening month. But we did it just to see what uptake we had, and we had quite a bit, which got us a little bit closer to working. But that’s exactly where we started. Along the way, we learned as much as we could.

Troy Trygstad, PharmD, MBA, PhD: You probably learned a lot from the folks you were referring to.

Tripp Logan, PharmD: Oh, for sure, for use.

Troy Trygstad, PharmD, MBA, PhD: What other unmet needs? Housing, food, working with law enforcement? What comes to mind?

Tripp Logan, PharmD: Environment is a big one.

Troy Trygstad, PharmD, MBA, PhD: Environment, so elaborate on that.

Tripp Logan, PharmD: So, a lot of the folks that we’re dealing with—transient for one, no cellphone minutes of the call, food is another thing. And a lot of them are in government housing and so it’s just them and they’re there. A prime example is we had a gentleman we were taking care of, he was getting his injections at the behavioral clinic, but we were caring for him. And bed bugs, right? So, he got bed bugs in his couch and bed, and it completely threw him for a loop. He went from being fairly stable on all his medications to he was manic and then, it was up and down, up and down.

And so, the environmental triggers, there’s more to it than just what’s on the box of that visit in the pharmacy or on that call. Life’s happening all around. And then the stigma of bed bugs followed this gentleman to the point where he’s no longer living on his own, he’s living in a center. Hopefully, he gets to go back out on his own, but it’s that 1 trigger that sent him down this path. And we’ve been caring for him for 10 years. So, you just can’t go home with everybody, but you can do everything you can to facilitate a proper environment.

Troy Trygstad, PharmD, MBA, PhD: Right, but you noticed the trigger.

Tripp Logan, PharmD: Yes, he was wanting me to haul him off his bed. I was like, “Man, I’ll go a long way but I’m not getting close to the bed.”

Troy Trygstad, PharmD, MBA, PhD: What if the pharmacy’s not following a patient like that? Right? Then what happens? If you’re not there, play it out, what happens?

Tripp Logan, PharmD: Well, it played out through a couple different avenues before it got to us, because we were aware of it. We weren’t aware that one of the reasons he couldn’t be back to integrate into his normal life is because he was out of his apartment, right? And so, they wanted us to haul it off. We did find a trash service finally that would go and pick that up, but somebody’s got to pay for it. Luckily, the state picked it up. But you know, that’s 1 example. That’s 1 story. It was less expensive on the system. It was better for him when he lived by himself and he could control his own life from day-to-day. But now he’s in a center, it’s more costly for everybody, it’s not better for him, it’s just a tough situation. That’s 1 story.

Troy Trygstad, PharmD, MBA, PhD: How’s he doing now?

Tripp Logan, PharmD: He’s still there. Actually, he calls our pharmacy every day just to check in. Still every single day. He used to be a walk-in but now he calls every day. Says he’s going to be back, and it has been 6 months.

Troy Trygstad, PharmD, MBA, PhD: So, Carla, you’ve been in practice for how long?

Carla Cobb, PharmD, BCPP: Twenty years.

Troy Trygstad, PharmD, MBA, PhD: In a community health center?

Carla Cobb, PharmD, BCPP: Yes.

Troy Trygstad, PharmD, MBA, PhD: You heard Tripp’s practice model, you heard Adrianne’s practice model, how well would these patients fair if they had to get their drug via mail order?

Carla Cobb, PharmD, BCPP: Not well, typically. And that’s the whole all-hands-on-deck, as many touch points as they can have, as many visits with people who are interested in them, who care about them. Often people with serious mental illnesses don’t have a good social support system. They are often single, they don’t have many friends, they’ve burned bridges with family members at times.

Troy Trygstad, PharmD, MBA, PhD: Which is self-defeating because the triggers, you need folks around you that identify, right? And if you don’t have that structure, then it’s a down-road spiral without a whole lot of knowledge.

Carla Cobb, PharmD, BCPP: And even sometimes just the symptoms of the illness prevent people from having these relationships. So, having relationships with members of an ACT team or pharmacy, pharmacists and staff, that is very meaningful to these patients. And sometimes, maybe the only social interaction they get.

Tripp Logan, PharmD: It’s stabilizing.

Carla Cobb, PharmD, BCPP: Yes, I agree. And that’s why they like to walk in and call and have that support.