Plan offers a tremendous opportunity

The Head of Medicines Strategy for Mental Health and Learning Disabilities at NHS England and NHS Improvement gives his views on the NHS Long Term Plan and what it could mean for improved mental health care: 

The NHS Long Term Plan is good news for patients and service users.

I welcome the opportunity that pharmacy has been given to play a part in delivering better services. Alongside several other areas for investment, the plan highlights mental health as a much-needed priority area.

From a pharmacy perspective the plan gives us a tremendous opportunity to redesign our services within an overall spirit of collaborative care and to focus on delivering the improvements in the use of pharmacological treatments in mental health that we all want to see.

Many of the mental health commitments within the plan recognise the earlier work outlined in The Five Year Forward View for Mental Health in 2016 and the expectation is these will continue as priority areas.

Within mental health, we will see new services for children and young people delivered within a new model of care for people aged 0-25 years. We will see this group receiving a greater proportion overall of the £2.3 billion investment in mental health services.

We can also expect an expansion of mental health support teams who will work with schools and colleges. Whilst the focus of support from these teams will be to strengthen the non-pharmacological treatment and support offer –  there’s no doubt there will be some opportunities for pharmacists, with the right expertise, to work alongside – or within – these teams, to ensure the best use of medicines (or no medicines) for children and young people with mental health problems.

In adult mental health services, the plan builds on the commitment outlined in the forward view to increase the number of people with severe mental illness (SMI) who will receive annual physical health checks. This is part of the wider ‘whole health’ commitment to tackle the unacceptable premature mortality of people with SMI who die some 15-20 years earlier than the rest of the population.

As part of the programme of work to improve mental health care for people with mental health problems in acute/general hospitals, we can also expect further developments in the number of psychiatric liaison teams providing support for people of all ages in acute general hospitals. Opportunities may also emerge to strengthen these teams by including specialist mental health pharmacists as part of a multidisciplinary psychiatric liaison service.

New models of community-based services for people with SMI will be developed and mental health pharmacists will be part of this new offer, aligning with primary care. We will also see the deployment of many more clinical pharmacists across primary care networks (PCNs) who will need to have the right levels of skills to help support the substantial number of people who have common mental health problems, with their medicines.

With their focus on structured medicines review, these new clinical pharmacists in PCNs will be a resource to help tackle some of the long-standing, medicines-related problems experienced by people whose treatment with medicines for both their physical and mental health has been sub-optimal.

Working closely with pharmacists who have specialist expertise, I would expect to see clinical pharmacists in PCNs supporting the Stopping Over-medication of People with learning disability, autism or both and Supporting Treatment and Appropriate Medication in Paediatrics campaign to address the inappropriate use of medicines for people with a learning difficulty, autism or both. Having access to specialist pharmacists within wider PCNs will, I am sure, help support the better and safer use of medicines.

There will, of course, be a need to improve and maintain provision for in-patient psychiatric care. So, while pharmacy teams need to be working with their colleagues to develop non-hospital-based services, it will be important to maintain high quality and safe medicines use in in-patient units.

Reducing and preventing suicide will remain a priority. All pharmacists and pharmacy technicians should be involved with local suicide prevention programmes. Their focus should be to reduce the risks of medicines-related self-harm and ensure that this is linked with wider programmes to support patient safety.

Although the additional resources for mental health are welcomed, it is also important to recognise the whole system shift in culture which runs through the NHS Long Term Plan. We will need to embrace the integrated care systems’ and PCNs’ ways of working, with collaborative working to ensure mental health medicines expertise is available across traditional organisational boundaries of care.

Pharmacy leadership will be a crucial part of delivering the pharmacy and medicines elements for mental health. We need the capacity to step up and deliver the better medicines-related outcomes that are expected from the additional investments.

The NHS Long Term Plan is good news for people with mental health problems, and it should be welcomed by the pharmacy profession as offering the opportunity to make a substantial contribution to the lives of people with mental health problems through the better use of medicines – or no medicines.

Peter Pratt has worked as a specialist pharmacist in psychiatry for over 35 years.

Prior to joining NHS England and NHS Improvement, he was the Chief Pharmacist at Sheffield Health and Social Care NHS Foundation Trust. He has extensive experience of psychopharmacology and pharmacy practice in mental health throughout the UK.

He is a former Chairman and a Fellow of The College of Mental Health Pharmacists, a Fellow of the Royal Pharmaceutical Society, and a former executive board member of the National Association of Psychiatric Units.

In addition to his national role, Peter has helped shape the national guidance for medicines use in mental health through his membership of several NICE clinical guideline development groups including schizophrenia, the management of violence and psychosis with substance misuse.

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