Welcome to a brief november 2021 update for my Lewisham mental health carers forum. The forum is an online forum and provides engagement for those caring for someone suffering mental illness. The speakers for November 2021
Li-ying Huang – South London & maudsley Pharmacist
Raymond McGrath – Lead Nurse : Integrating our Mental and Physical Healthcare Systems (IMPHS) for Mind & Body Programme
Li-Ying Haung presents on the importance of medication.
As we all known medication and mental health can go hand in hand, there are times when patients struggle with medication and unpaid families and carers feel there is a lack of information and engagement regarding medication.
Maudsley NHS foundation trust was kind to have their pharmacist present to families and carers at my Lewisham MH carers forum.
Li-Ying started off by saying her presentation was set in mind for patients and carers. The outline of this presentation is just to quickly go through what the mental health pharmacy does and the common tasks used to treat mental health conditions, this includes side effects where most people would want to find out a bit more about because of being anxious regarding medications. The presentation covered how to stay well, the road to recovery including finding out more information.
Li-Ying presented on the Common types of medicines used to treat mental health conditions
A run down was given below.
Antipsychotics – treat and prevent psychosis (e.g. in schizophrenia) and in the short term treat anxiety and disturbed behaviour. Two types – typical and atypical
Antidepressants – treat moderate to severe depression
Anxiolytics/Anti-anxiety medication – alleviate symptoms of anxiety
Hypnotics/Sleeping tablets – treat transient and short-term insomnia
Dementia medication – to maintain function and promote independence
Mood stabilisers – treat and prevent mood fluctuations (e.g. mania)
Li-Ying then talked about side effects, where she stated that side effects can be very distressing and a great concern to carers, service users AND pharmacists/doctors All medication has side effects – paracetamol to clozapine and all in between – We must balance the beneficial effects against the downsides such as side effects
Sometimes people don’t want to take medication due to side effects – it’s important for the team to know this as if medication is missed it can lead to deterioration in mental health
There are so many other reasons why patients may not take our medication, reasons are forgetting meds /not believing they work/not feeling we need them
Li-Ying then moved on to presenting about sedation.
Where during inpatient stay there is often an initial phase of crisis treatment (sometimes medication such as benzodiazepines needed) then the next stages of the recovery process is to re-establish medication where appropriate, such as mood stabilisers and anti-psychotics, and move towards recovery – different medications may be needed at each stage (as in physical health crisis too). Sedation is a common side effect of many medicines used to treat mental illness – medication that causes sedation may not be needed long term though
However what can you do as a carer to get answers?
The following can be tried below.
Attend ward round – discuss with multidisciplinary team
Arrange a meeting with pharmacist
* To discuss specific drugs
* To get a general overview of how medicines can cause sedation/other side effects
Anything about an individual’s treatment would need consent to be discussed BUT we can discuss general queries with carers
Carers can also try
Getting GP support – Where South London & Maudsley recognises the need for more specialist medicines input into GP services and are currently looking at extending pharmacist roles to support local GPs
-Book appointment for medication clinics where Lewisham patients are welcome to attend nearest SLaM hospital as unfortunately no clinic at Lewisham.
Li-Ying mentioned that if you are unsure whether symptoms are an emergency seek medical advice and let the medical professional decide. Let a medical professional know the current medications that your cared for is taking. It can be useful to keep your own account of how your cared for reacted to their medications
There was also a presentation on interactions regarding medications and things to watch out for.
Lithium & low sodium diet
Sertraline & grapefruit juice
Carbamazepine & a lot of things
Fluoxetine & clozapine
Clozapine & smoking & caffeine
The road to recovery
Li-Ying finished up by stating medication doesn’t work fully in every case and as we know, many people need much more support than medication to help them get better. With medication it can often be trial and error which is distressing and frustrating. Sometimes it can take a couple of months to see if a medication is of benefit before it can be ruled out. Eventually more research could lead us to personalised medication and predicting based on DNA what medication will be most useful for an individual.
More and more research being done into studying what medication works best for individuals (pharmacogenomics) but we have to use what we have currently (i.e. medications with side effects as well as benefits) in the best possible way – collaboratively and honestly
Medication is part of the treatment package – Obviously Li-Ying’s area of expertise is medication so it can be difficult to know in depth about other treatment options available but non-medicine examples include:
Help with benefits and budgeting
Psychology – Cognitive behavioural therapy and other therapies
Daily activity planning/Occupational therapy
Choice is very much individual as every individual needs different steps to help them recover. Healthcare professionals can help to identify the most suitable options for individuals but not everybody can be managed without medication. Medication is still an important part of recovery in many individuals
Raymond McGrath presents on Integrating our Mental and Physical Healthcare Systems
Raymond started off by saying this project was a three year project funded by the Maudsley charity is looking at integrating mental and physical health care systems, and they have done a lot of work on service and development, quality improvement, evaluation research and so on.
They have put out an expert by experience role for carers or patients to sit in their steering group, where one of the members of the Lewisham group actually got the post.
So a lot of our work so far has been looking at the work that goes on in inpatient settings, they appreciate that the majority of their patients are actually held in community. So what the project is really about is, they want to kind of understand how the community mental health are supporting the physical health of SLaM service users. So that they can basically produce a report on what to improve. They also think this is going to be generalizable to other mental health trusts around the country. So some of the things they are kind of interested in talking about is looking at staff skills, and staff knowledge, they are also looking at the team and organizational structure, looking at half staff program, physical health, there are things like the relationships with charity organizations with GPS.
Raymond noted that the Professional Records Standard Body (PRSB) has been asked to update and enhance their Digital Care and Support Plan information standard, so that care plans can be effectively shared between patients, carers and all the health and care professionals involved in that person’s care. The standard will support digital sharing of care plans for working-age adults with severe and enduring mental health conditions being cared for in the community.
Raymond mentioned the consultation questions were
- Is there any other information about a person that is necessary to support care planning in community mental health that has not been shown in this document?
- What information should be recorded about a treatment or intervention (e.g. outcome, patient experience, dates, lead professional)?
- Is there any other information that should be included in the care plan?
- Is there any other information that should be included in the crisis care plan e.g. early warning signs / relapse indicators?
- What additional sources of information, that may be held elsewhere in NHS or social care systems, should be referred to in a care or crisis plan? For example, presence of an advance statement, advance decision, About Me, Lasting Power of Attorney, contact information for care co-ordinator, family members, statement of preferred place of care.
- What type of information about a person’s carer should be recorded in an individual’s care or crisis care plan?
- Is any other information needed in a care or crisis care plan to aid transition a) from child and adolescent mental health services to adult mental health services or social care services or b) from adult to older adult mental health services or social care services?
- Is there any additional information from social care that should be included in the care plan that is not covered by the existing standard?
- What are the benefits of a single care plan shared across health and social care for an individual covering physical and mental health and social care?
- What are the barriers to implementing a single care plan covering physical and mental health and social care?
You can find out more about Kings Health Partners off the website below
This concludes my update for November 2021