Approximately one in five adults in the United States live with a mental illness and a survey published by the CDC found that 16.5% of American adults have taken prescription medication for their mental health. As the medication experts of the health care team, pharmacists are uniquely positioned to have an impact in mental health.
In the final Career Seminar presentation of the 2021-22 academic year, College of Pharmacy and Pharmaceutical Sciences doctor of pharmacy alums Glen Chase (’15) and Aubrie Duke (’16) from Comprehensive Healthcare in Yakima, Washington talked to WSU doctor of pharmacy students about pharmacy roles in psychiatric care.
Chase and Duke are both prescribing pharmacists with a collaborative practice agreement which allows them to perform psychiatric evaluations, initiate and modify medications as appropriate, and order any necessary lab work.
“I think the most rewarding part is that we get to personally make decisions that improve our patients’ lives,” said Chase.
Chase provides psychiatric care for the Yakima County Department of Corrections and provides intensive care to those with severe mental illnesses (including schizophrenia, schizoaffective disorder, and bipolar disorder) for the Program for Assertive Community Treatment (PACT)—a high intensity team comprised of providers from several disciplines working together to care for patients.
Through PACT, Chase sees between five to ten patients per day in 30-minute to one-hour appointments. PACT appointments often entail the provider traveling to see the patient in the community for those who have difficulty coming in for appointments.
Chase explained that by seeing them where they live, “You can really see a very, very clear reflection of their mental illness and how their stability is doing, based on the environment they’re in and how that interplay occurs.”
Duke is a medication provider who manages patients with mental health and substance use disorders in both outpatient and inpatient settings. In the outpatient setting, Duke explained that the goal is helping patients manage symptoms in the long term. Duke has a caseload of 315 outpatients who she sees at regular intervals usually anywhere from every month to three months. In a typical day, Duke sees up to 16 patients during 30-minute appointments where they review any medication, lifestyle, or behavior changes discussed during previous visits.
“This is my favorite part of my job. I get to work one on one with my patients. They’ll bring in a problem, we work on the solution to that problem together, and then they get to go implement that solution,” explained Duke. “Then they come back, and they tell me if it worked, and if it didn’t, we problem solve again.”
Duke works in an inpatient setting approximately once a month, where she will see eight patients in a day. Often these patients are acutely psychotic manic or suicidal and are detained to the unit until they are stabilized and ready to return home.
When the COVID-19 pandemic hit and restrictions on in-person appointments were put in place Chase and Duke found themselves forced to alter how they interacted with their patients.
Duke’s appointments moved largely to video and phone where she learned to ask different kinds of questions to make up for the inability to pick up on the same visual cues as during face-to-face appointments. “It’s really tough to tell somebody’s mood over the phone,” said Duke.
Due to the nature of PACT, as long as they could do so safely, providers such as Chase continued to see patients in person, often outside with appropriate PPE.
“You can’t count on someone who’s a poor historian to appropriately report symptoms over the phone,” explained Chase. “You have to be able to lay eyes on them. I have patients that most of my medication decisions actually has to do with what I see, not what they’re telling.”
Both Chase and Duke also said they saw heightened anxiety and depression among their patients during the pandemic.
“When you don’t challenge anxiety in a particular area, it can get bigger and after a while, where going to the store used to be really anxiety provoking now just going out of the house is anxiety provoking,” explained Chase.
For current pharmacy student interested in pursuing psychiatric pharmacy, Chase said it takes ambition and a willingness to take professional risks by demonstrating the value of pharmacists. He also recommended doing a psychiatric rotation as a great way to start getting a specialty certification. Chase explained that for other providers the specialty certification can serve as a common language showing standardized extra training.
The presentation was part of the Preparing for Change Career Seminar Series, which the college coordinates to introduce student pharmacists to career opportunities and leaders in the pharmacy profession.
The seminars are funded through the WSU CPPS Dean’s Fund for Excellence and our community partner, the Spokane Teachers Credit Union. For information on participating in the Career Seminar Series, or to contribute to the Dean’s Fund for Excellence, contact the CPPS advancement office at gocougs@pharmacy.wsu.edu or 509-358-7651.