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.

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.