Mental Health & the Importance of Adherence

As a pharmacist, you’ve probably witnessed the impact adherence has on mental health, or you know colleagues who are successfully using adherence packaging for behavioral health clients.

But with the backdrop of rising mental health problems associated with the pandemic, the issue is taking on increasing importance.

According to the CDC, 1 in 5 Americans will experience a mental illness in a given year. Treatment for nonadherence in patients with mental health issues is similar to or higher than with other chronic conditions, but is rarely addressed in routine clinical care.¹ More than half of patients with depression, schizophrenia, or bipolar disorder have problems with adherence.²

RxSafe and Todd Eury, with the Pharmacy Podcast Network, recently teamed up on a webinar entitled, "Mental Health & the Importance of Adherence.” The educational session, which featured mental health experts and pharmacy owners, demonstrated how community pharmacists can have a direct impact on mental health outcomes by identifying symptoms of mental health disorders and by closely monitoring medication adherence.

Click the video image above to watch the complete webinar.

Below are excerpts of the Q&A with the panelists, who include:

  • Dr. Monica Krishnan, PharmD, “Pharmacists Focused on Mental Health” Podcast
  • Dr. Tyler Young, PharmD, Hines Prescription Shope, Barnsville, GA
  • Dr. Thomas McDowell, PharmD, McDowell’s Pharmacy, Scotland Neck, NC

Question: How can pharmacists be more aware and recognize symptoms associated with mental illness?

Dr. Krishnan: “I think it's all about connection. Being able to connect one-on-one with the actual patient that comes to the pharmacy counter. I know, for me, specifically being a community pharmacist, it's at the consultation counter. And listening, listening is key. And from someone who not only is a clinical pharmacist, but who has been a mental health patient herself, that gives me a little bit more credibility, power to let my patients know that there's no judgment. There's no judgment, because I'm not going to judge you if you're taking Lexapro or Trazodone, because I'm not going to judge someone who's taking metformin for diabetes, or
judge someone who's taking albuterol for asthma.”

Dr. McDowell: “We're the most accessible healthcare providers in the community, oftentimes. And so we're seeing our patients 10, 12 times a year, at least, compared to, they may only see their primary care provider or mental health provider a couple of times a year. And so we have the ability to see how the patient is doing on a regular basis. And we want to let them know that we are here to support them, not just with the typical chronic conditions, but with all conditions. And mental health is really important to us. And my grandfather, who was pharmacist, really had an inclination to want to help mental health patients. And he served in World War II, and he was at the Naval Hospital in Bethesda, and saw a lot of patients that were suffering from mental health issues. So it's been really near and dear to his heart, my father's heart, and myself as well.”

Dr. Young: “I think one of the most important parts is building that relationship with the patient. Unfortunately, in some retail settings, there's not the staff or the time to make that happen, but I believe every pharmacist and technician wants to have that relationship with their patient. And once those relationships are created, you can begin to recognize if and when something is off about the patient. They may not have any diagnosed mental health condition, but if they're going through a rough patch and all of a sudden they develop depression or
other issues, you can notice when those things are off, if you have that relationship.”

Question: How does stigma play a role in our increasingly growing mental health crisis?

Dr. Krishnan: “I feel like the past two years we have, especially being in the largest mental health crisis, not just in our country, but truthfully, globally, as a result of this pandemic. I feel like we are starting to see more conversations with mental health stigma, especially just in my community where I work in Los Angeles. No one really wanted to go to urgent care or ERs or doctors' offices unless they absolutely had to. So they were coming in to pharmacies. And I cannot tell you the amount of conversations I've had with parents, teenagers, adults, who are wanting to have more conversations about their child or themselves going on one of these medications.

So I think that we are heading in the direction where conversations and the stigma is starting to break a bit. We're not there a 100%, but I think this pandemic has truthfully opened the doors of addressing the importance of mental health is just as important as physical health. So I think we're working in that direction. I think education is key, understanding why this particular medication, let's say, for example, Lexapro, how does that work in the brain? What are these neurotransmitters in the brain like norepinephrine or serotonin? And how does it work? And, okay… if this drug isn't working for you, let's switch it to this one. So I feel like as a community
pharmacist, I am seeing more acceptance.”

Question: What have you experienced with your patients who are suffering with some type of mental health or behavioral health issue, they are on a treatment, but they're also diabetic or they have hypertension or they have something else? As many as 56% of patients that are on some kind of antidepressant, are more likely to be nonadherent, so how do you overcome or help to overcome those challenges for your patients?

Dr. McDowell: “A lot of times, they might put the mental health medications on the back burner, if they're worried about diabetes at the moment or hypertension. And a lot of times they don't have time to discuss mental health in detail at their doctor's visits. But we try to make sure we're keeping track of all of the medications they're taking, and make sure all disease states are paid attention to. And our adherence packaging program makes that a lot easier. We have several hundred patients enrolled, where we monitor them monthly. We have an adherence coach that calls them each month, checks in with them, make sure everything's going okay. If they say, "I don't need this, this month." We're going to dig into that a little deeper, "And so what's going on Ms. Smith? And why don't you need that?”, and see if we can figure out a resolution.

Mental Health webinar

It's been a challenging few months for a lot of our patients, a lot of them are elderly and they have felt very lonely, isolated. And so we try to make sure they know that we're here for them, and that they need to make sure they're still staying adherent.”

Question: What have you done with compliance packaging or the simplicity of presenting a way to stay adherent on medications? Can you share a story of your experience in your community pharmacy?

Dr. Young: “We really focus on, with our packaging system, anybody who is taking more than about three or four medications; it can get really complex. That includes your mental health meds, if they have diabetes or hypertension. We talk about the importance of staying as adherent as possible, especially to their mental health medications, because most of these patients have worked very hard to get on a regimen that works for them. And we really stress how simple it is when we are able to package it for them. How they don't have to worry about what time they have to take it. It's going to have it on the package right there for them. They don't have to worry about, Have I already taken this once today?’ If they've torn off that little strip, then they'll know that I've already taken my medications for the morning.

"And so we are proactively ensuring that they don't become nonadherent. And we're getting ahead of the problem, because we're calling them before it's even time to refill their medications."

And we've got one particular patient who was really struggling with her mental health. She had a sister that she was caring for and some things were going on with her family and with her sister. And she ended up having, basically, a breakdown herself, and ended up needing counseling and therapy and some medications to work through that. And for a while, she would come in and only pick up one or two. And after discussing what was going on with her, we realized that it was kind of a price issue. So she was picking and choosing which medications that she was going to pick up that time.

And what we did with her was we set up an account for, basically, where she could just pay once a month. And we worked with her on her finances with that. And we got everything synced up to one fill day. And then we talked to her about packaging, and she was more than happy to do that. Once all those barriers were removed, she was able to be much more adherent. And now she's doing a lot better. For the first few months there, she was really struggling. But here in, I guess, the last six months she's done way better than she was previously doing.”

Question: How are you seeing the difference between picking up nonadherence with the packaging and the adherence tools that you have, versus before you had those tools?

Dr. McDowell: “Great question. Before we really increased our volume of adherence packaging, and got a RapidPakRx robot, we were doing it manually. We didn't have a lot of volume. We were much more reactive to situations that were coming up, and it made it a lot more difficult to see those problems happening ahead of time. And we would see them when we're filling medications, hey, they haven't gotten their Zoloft filled, or they haven't gotten their Trazodone. And at that point, we would still try to make a note to speak to the pharmacist at point of sale, and have that conversation, and ask them what's going on. But as we shifted more and more of
our volume to adherence packaging and med sync, where either way we're monitoring them monthly, but we're calling them ahead of time, seven days ahead of time.

And so we are proactively ensuring that they don't become nonadherent. And we're getting ahead of the problem, because we're calling them before it's even time to refill their medications. And if there's an issue, we can go ahead and resolve it right there, during that phone call or bring the pharmacist in. If there is a clinical issue or if there's a side effect, we can with the doctor or talk to the patient about that side effect. And so instead of seeing that they've missed a fill and it's 30, 60, 90 days late, we're talking to them at the time that they're
getting their medications refilled or packaged. And it's just a much more proactive approach. And we've seen a huge deal difference in some of these patients being stable on their regimen.”

To learn more about mental health issues in pharmacy, and the latest research, or to reach out to any of our panelists, contact us or leave a comment below.

Or, for more information about RxSafe's adherence packaging products and how they can help
your patients become more adherent, visit our product page.

² Valenstein M, Gaznoczy D, McCarthy JF, et al. Antipsychotic adherence over time among patients
receiving treatment for schizophrenia: a retrospective review. J Clin Psychiatry. 2006;67:1542-1550


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