24 February 2014
Alan Rosen (Co-chair), John Allan (Co-chair), Tim Lambert, Tim Chen, Andrew McLachlan, Sam Stott, Kerin O’Halloran, Rod McKay, Timothy W, Aoife Davis, Michael Tam, Judith Mackson
Titia Sprague, David Kitching, John Feneley (NSW Mental Health Commissioner)
Danielle Keogh (Mental Health Commission of NSW)
Carlton Quartly (Mental Health Commission of NSW)
Scott Thompson (Mental Health Commission of NSW)
Alan Rosen provided an Acknowledgement of Country and an Acknowledgement of People with Lived Experience of Mental Illness.
2. Welcome and apologies
Alan Rosen welcomed members. The apologies of John Feneley, Titia Sprague and David Kitching were accepted.
Members of the group introduced themselves and provided a brief background of their experience and interest in the area of pharmacotherapy.
3. Confirmation of agenda and declaration of interests
The Agenda was confirmed. Rod McKay declared that he is a member of the Expert Advisory Group for NSW Therapeutic Advisory Group’s Mental Health QUM National Indicator Project.
No other declarations were made.
4. Terms of Reference, membership and roles
The following changes were requested to the terms of reference:
- the word ‘patient’ be changed to ‘consumer’ at point 2
- that ‘carers’ be included at point 4
- a 6th point be added that refers to, understanding variability in respect to medicines due to factors such as geographic ancestry, cultural diversity, interactions with social conditions and implications for training.
5. Commissioner update: Mental Health Commission of NSW
In the Commissioner’s absence, Alan Rosen provided the group with a brief overview of the purpose of the Commission.
6. Commissioner update: Draft Strategic Plan for Mental Health in NSW
Carlton Quartly updated the group on the process that has been undertaken for development of the draft Strategic Plan for Mental Health in NSW.
7. Key issues and opportunities
There was discussion about the key issues and opportunities in the area of pharmacotherapy in Mental Health. Key themes included:
- That there is a need to humanise interactions through mental health care and this includes pharmacotherapy and pharmacy.
- Pharmacy needs to be grounded in principles of trauma informed care and recovery orientated practice.
- Consumer and carers require access to targeted and accessible information on medication.
- Training in mental health and the lack of pharmacists that specialise in mental health was noted as an issue.
- The need to identify issues and gaps in the area, but also to analyse why these gaps and issues have arisen. This analysis can then assist to determine solutions.
- Consumers and carers need to be educated on the questions to ask clinicians.
- There is a need for clinicians to value the lived experience of consumers and carers. An ‘equal footing’ is required in order for consumers and carers to feel confident when advocating for themselves.
- The potential for pharmacists to be part of the treatment team, and / or as part of the Partners in Recovery team.
- That medical students are no longer trained in pharmacotherapy.
- That for some consumers, in some settings and uses, opioid medication is viewed as chemical restraint.
- Any solution needs to be both consumer / carer focused and professional focused. Any divide here is to be avoided.
- The need for an evidence base.
- Polypharmacy can become a cycle of treating one condition, experiencing side effects, and then treating the side effects.
- Issues with adherence to medication.
- Clinicians, as regular practice, must routinely ask consumers about side effects.
- The concept of a ‘key’ mental health pharmacist in an area/LHD be nominated. Consumers could then have a trained contact for prescription filling and advice.
- Treatment plans should be transparent. This would then allow the pharmacist to be aware of the intended outcome the prescriber is hoping to achieve.
- The need for transitions of care to be better informed. Correspondence is currently infrequent and not detailed enough.
- Investment in ehealth is needed. Also better ways to share and gather data.
- The need to better understand non adherence to practice. There is plenty of evidence based guidelines but they fail to be properly implemented by clinicians.
- Medication is often seen as the simple solution by carers and families.
- GPs are not specialists and we need to consider how we support GPs to adopt better prescribing practice.
ACTION 2014.01: The Commission will develop a position paper which outlines the current issues and opportunities in NSW in relation to pharmacotherapy and contextualises this against best practice nationally and internationally. The Group will act as a reference point for the development of the position paper.
In accordance with the Terms of Reference the next meeting will take place in six months time. Out of session the group will continue to be consulted by the Commission on relevant matters.