Tag Archives: mental health

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The Bloom Program

Before you all jump on me for using another lawn/garden reference, please know that this is purely coincidental (though it does go tidily with the growth of our profession).

On these pages, I have written about my experience with the More Than Meds program. Its philosophy is entirely patient-centric. It uses a pharmacist’s medication expertise and accessibility to promote early intervention at the community level. Networking with my local mental health and addiction service centres has been eye-opening. for someone who prides themselves on having a good understanding the pharmacy side of things, gaining a first-hand perspective from those living with mental illness has made me realize just how deep stigma can run. Patients will send family members to pick up prescriptions because they feel judged at the counter. They may feel is distrust of the ‘system’ and feel no satisfaction due to treatment failures or embarrassing side effects. I was missing tools on how to listen properly instead of simply force-feeding advice. I stopped assuming that what I wanted to tell someone about their new therapy was what they wanted to hear. My line of questioning became much more open-ended.

So fast-forward to the current day. The next iteration of this mental-health community outreach project has become the Bloom Program. In partnership with the NS government, this demonstration project (a study to demonstrate value of an intervention) has been funded to build on the positive feedback generated. It is starting out small with only select sites approved to enroll patients. In doing this, promotion has been fairly under the radar with sites being responsible for making contacts within the mental health community where they are located. My chance was early December when I was invited to a nearby hospital to briefly introduce the program.

I was nervous. Unsure of who would be in the audience, I went over in my head the history of the program and the philosophy of the approach. Those involved with Bloom believe strongly that early intervention in mental health illness, in terms of recognizing potential problems and building a support network, can mean the difference in the lives of individuals and their families. As front-line practitioners, pharmacists are often the first point of contact for those unfamiliar with available services in the area, but not all pharmacists will know themselves where to turn or how to refer. To meet that challenge, a resource called ‘The Navigator’ was put together. Broken up by health district, the Navigator attempts to capture as many of those services in the form of ‘helping trees’. For any query, be it crisis-management, sexual assault, suicide, legal aid, continuing care, social services, etc, a list of groups and their phone numbers are available in one place. This has proved invaluable on a number of occasions to give people options to try. Sometimes I find myself calling on someone’s behalf to gather information on intake procedures or meeting times for various support groups.

That said, I’ve been guilty of harboring a sense of intimidation when the word ‘specialist’ arises. I have a feeling that many practitioners, from both the pharmacy and medical sides prefer not to challenge drug therapy regimens due to the relative complexity of the symptoms being treated and the associated adverse effects being managed. Sometimes it gets lost that many folks diagnosed with a mental illness often have smoking habits, poor sleep, or family history of diabetes and hypertension. These conditions need a similar amount of attention and may indeed be exacerbating the highs and lows.

In some ways, it was better that I didn’t know to whom I was speaking. There were about a dozen in the room and at least two specialists. Nurse managers from different departments (outreach, addictions) were in attendance and curious as to how I would be looking to work with them. Hopefully, they went away with a bit of inspiration to have a deeper collaboration with community pharmacy. I just need to be ready when they do.

 

 

Disclaimer: The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of any agency, employer or affiliation.

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The Unexpected Experience of Mental Health Outreach

Since May, I’ve been a proud member of the More Than Meds team (@morethanmeds, http://morethanmeds.com). I’ve been led off the beaten path of conventional community pharmacy and have begun to test my own beliefs about mental health and stigma that goes with it. I’ve certainly had my eyes opened, and many doors and opportunities too. I think it is fair to say that being a part of this program has really helped me to better understand what patients and their families go through on a daily basis – the hope, exasperation, set backs, isolation, support, and progress. This understanding didn’t happen by remaining in the dispensary.

About four weeks ago, I was invited to attend a meeting with family members of patients struggling with psychotic and schizo-affective disorders. This group has been meeting monthly for about 10 years now. From what I observed, they have grown into a big supportive family. Mostly there were couples, but some single parents attended. Each would provide insight and support to the others in the group by sharing their own experiences with mental health services, inpatient stays, the multitude of care providers, challenges with housing, and of course, the medications. While I am very familiar with the commonly used psychotropic medications, I am far out of my comfort zone when it comes to addressing the non-pharmacological issues of mental health care. While I knew it on some level, being at the support group really crystallized for me the importance of being much more than meds (see what I did there?). Educator, navigator, collaborator, and advocate (definitely advocate) roles make much more sense now, whereas before I didn’t really ‘get’ how to fit them into my practice. Quite frankly, I was overwhelmed by how much information I had to offer. Information that they needed, information that brought the members of the group understanding and clarity and/or new therapeutic paths to follow. Their appreciation was more than humbling.

During a round-table discussion, a member of the group touched on something that I can’t seem to shake, and I paraphrase:

“Our son lives with schizophrenia. He’s been doing well of late. His meds are stable. He is living independently. When he was a teen, he was a gifted athlete and musician. Now mostly he plays video games. We actually get concerned that he has stopped his medications when he gets back to playing music…and he’s really really good!”

This comment really struck me, flooding me with all sorts of thoughts and mixed emotions. This illness, especially the negative symptoms, is so frustrating to families, and to me. What can we do to help? Are his medications stifling his creativity? The concept of blunted affect has been written about extensively (http://en.wikipedia.org/wiki/Blunted_affect, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2632232/). Would suggesting a change in his pharmacotherapy be a good idea? Does it keep hope alive or set up false expectations? How do we say in so many words, “things could get better. Would you like to try (x)”? Simply by saying it we are, in fact, pointing out that the current situation is somehow unsatisfactory, but who are we to judge? This may be counterproductive as it may only serve to cause the family frustration rather than hope. As pharmacists, we may struggle to determine our role in these situations. We do not title ourselves as mental health care specialists but we do contribute to mental health services. In a broad sense, we contribute every time we speak with someone about their sleep, their mood, their worries, and the medications that affect those things.

That said, I am glad that I chose to accept the invitation to speak. Even just to be a part of  a community searching for help and support. On the topic of medication regimens: sure, they help the families and caregivers cope. They can also provide stability, the lack of which could otherwise prevent the return to work or leading to the loss of yet another relationship. However, not everyone likes the medication experience. It’s been said that the cost of stability may be a little less color in one’s world. For that evening, I may not have had all the answers to their many questions. I may not have been able to recite the most relevant head-to-head trials or know all the rare side effects for each medication, but I learned that my imperfect knowledge and my experience allowed me to give so much in the way of support, information, and encouragement.

After a couple of sessions with families and patients, I don’t consider myself an expert but I certainly feel that my awareness has changed for the better. I hope to participate in more evenings like the one mentioned above.  I know my daytime patient care activities will benefit from it.

Disclaimer: The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of any agency, employer or affiliation.