Mental Health Pharmacy

Dr G Akram
HW 501D
 Mental (ill)Health
• 1 in 4 of UK adult population is affected
• Depression is largest single cause of disability
• 5 of top 10 causes of disability in 15 - 44yr old are mental
health disorders
Most psychiatric disorders have a neurobiological basis;
manifestation of the condition is largely a combination of
genetic, social and individual factors.
Stigma and Prejudice are still rife when dealing with mental
illness.
Mental illness may be likened to: demonic possession, religious
error (as a punishment from God), poor parenting, lazy / weak
individuals (“pull yourself together”)
 Prejudice / Stigma
Prejudice: An unfavourable opinion based on
inadequate facts
Stigma: A mark of discredit or shame
(Tends to arise from ignorance & fear- like racism, homophobia)
Contributing factors:
• Family / friends, health professionals / system, society (media)
• Self inflicted? (co-morbidity with alcohol & drugs)
• Emotive area (children, questionnable evidence base,
psychological treatments)
 Prejudice / Stigma
contributing factors
• Problematic (vulnerable) population e.g homeless
• Cultural and religious factors (voodoo, spells)
• Interface between health and criminal justice systems
• Perception of normality (odd behaviors – feared or
shunned from ‘normal’ society.)

Stigma is one of the biggest factors/hurdle in people

seeking treatment for MH conditions
 The media: sensationalist &
biased
SLAUGHTER OF THE INNOCENTS: Killer mum’s
mental Illness. (The Mirror, Feb 15, 2006)
City fire attacks menace is caged (Birmingham Evening
Mail. Jan 30, 2007)
TESCO and ASDA fancy dress ‘mental patient’ costumes
(Oct 2013)

• People with mental health problems are less likely to be

employed and are more likely to experience harassment.
• Nearly 9 out of 10 people with mental health problems
have been affected by stigma and discrimination, with
two thirds saying they have stopped doing things because
of the stigma they face.
 Anti-psychiatry movement
Philosopher M Foucault: a form of ‘Social Control’ (Human
Rights abuses by governments, labelling of individuals)

Myth of Mental illness: medicalisation of normal behaviours /

emotions i.e ADHD, anxiety

Influential bodies/organisations e.g Church of Scientology,

other pressure groups which can lobby govts etc - “no such
thing as chemical imbalance, psychiatry is pseudo-science”

http://www.antipsychiatry.org/
“Schizophrenia does not exist- it is an invention, a
spurious attempt to medicalise patterns of behaviour
that are better understood in social or cultural terms.

It is a political act, designed to marginalise, victim

and persecute someone who is merely reacting to the
ills and hypocrisies of contemporary society”- T Szasz
 Pharmacy
“Most people generally positive about pharmacists and
their staff, but some voiced worrying concerns such as:
being treated in an ‘off hand’ manner, or a lack of sensitivity
shown by counter staff (asking embarrassing questions
within earshot of other customers), and not been given
enough information about side effects or even what the
medicine is about, especially when it is used unlicensed”.
http://www.dh.gov.uk/assetRoot/04/07/91/16/04079116.pdf

• What are your prejudices/ biases?

• How empathic are you?
 Classification
• Diagnostic classification using ICD-10 or DSM V (Diagnostic and
Statistical Manual for Mental Disorders –updated 2013)
• ICD – official stats DSM – Clinical diagnosis/research

DSM V (Jeffrey Lieberman- President-Elect of the APA “DSM-5 is not a

pop-psychology book intended for consumers: “It is a guide, an aide to
assist clinicians to help facilitate treatment.”
Controversial diagnosis include: Intermittent Explosive Disorder,
Bereavement exclusion in depression, minor neurocognitive disorder,
excessive eating (once weekly over 3 months)= binge eating disorder

Frances Allen J (MD) blog- DSM is a guide not bible- Ignore its 10 worst
changes (not field tested, influence of pharma, determine eligibility for benefits &
treatments)
 Medication Compliance
Affected by
• Illness: lack of motivation, delusions, paranoia, insight
• lack of belief in the medication
• Placebo effect
• Clinical effect i.e delayed onset / numbing effect
• Fear that it is addictive or habit forming
• Need to implement ‘lifestyle changes’ i.e diet,
reduce intake of alcohol etc
• Side effects (mainly physical)
 Pharmaceutical Care In Mental
Health
• Promote safe, effective use of CNS and other medication
• Education and awareness of mental ill health
• Health Promotion (regular exercise beneficial to mental health)
• Discharge from hospital –(continuity of supply: what about depot,
clozapine???)
• Support Groups – patient not always willing to talk to family or to
health care professionals!
• Policy / Guidelines – make sure practice is up to date and safe