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58 MENTAL HEALTH FROM PAGE 57 five, six, seven or eight medications, he says. “This medication regime is incredibly complex, with each part deserving discussion, as does the whole set,” he said. “This is because patients want to know that this medication is meant to do this, and this one’s meant to do this as well. “The problem is made more complex because, as symptoms change and life changes, prescribers change or tweak medications, meaning that patients literally lose track of what they’re on. This makes for an incredibly complex medical and behavioural task.” This is where pharmacists play a “very special role”, Professor Murray says, which includes asking questions about the medication patients are taking and how it’s affecting them. “The role includes some understanding of the psychology of medication,” he said. “For example, we know that a significant proportion of people with serious mental disorders really don’t like taking their medication – and that’s not an exaggeration. The reasons are partly medical, in that the medication is not as effective as it should be, or it comes with negative side effects, but a major reason is the daily reminder to a person of the things that are the worst in their life and most out of control. “So, morning medication comes with the reminder that they’re sick, and of the traumatic and negative experiences they’ve endured – that life has proven difficult for them to cope with.” Professor Murray says healthcare professionals can empathise here, as everyone can imagine how keen they would be for a family member with a serious mental disorder to feel empowered, confident and able to live a rich and full life. Therefore, he says, the psychology of taking medication is an important part of the discussion between a pharmacist and a patient with a mental health disorder. “This centres around what it means to take medication for a mental health disorder, and this is not the same thing as taking medication for something like blood pressure, because that’s not about the patient, but mental health disorder medication is all about the patient, their history and frailties,” Professor Murray said. “So we would love to have pharmacists have a holistic perspective on medication in these instances and the difficult experiences the patient has endured, because in the moment that they take their medications they’re not neutral and they have to deal with the medication’s efficacy, its side effects and the psychology around taking it. These are major issues. “This is where pharmacists can play a role as not just providers of information but also as supporters on the emotional side through asking open-ended questions such as what’s it like to take their medication, what’s their view on it, and the like.” Telehealth counselling for the aged The focus on mental health in aged care highlights the importance of pharmacists being able to approach elderly people who show signs of suffering from mental health disorders. Swinburne University of Technology Professor of Psychology Sunil Bhar tells Retail Pharmacy Assistants he empathises with pharmacists on the frontline because very little information is specifically directed at how to approach older people suffering from mental health issues. However, having been a director for Swinburne’s Wellbeing Clinic for Older Adults for more than a decade, he says he has learnt much on the subject. Professor Bhar says the clinic launched a free, national telehealth counselling and support service for aged care residents and their families as well as aged care workers in mid-May to provide emotional support to older adults in care facilities. The clinic was opened in 2011, as an experiment to determine whether the university could reach older people living in aged care and offer them counselling and psychological treatment. A decade ago, he says, “there was very little of these types of services around”. “We also felt that it was a good opportunity to fill a gap in the service industry by training postgraduate students with some competencies in this area,” he said of the clinic’s early days. With the advent of Covid-19, aged care facility residents have been experiencing increased feelings of anxiety, loneliness and isolation due to RETAIL PHARMACY ASSISTANTS • OCT 2020