Background

Older people prescribed several medications are at great risk of mismanaging them and adherence with medication is known to prevent relapse and admissions to hospital. The Audit Commission recently found mental health services for older people to be patchy and inconsistent. Carers often lack support and information (1). The National Service Framework for Older People contains targets for medication reviews and schemes for assistance by pharmacists (2). A Derbyshire project involving the integration of community pharmacists into Community Mental Health Teams (CMHTs) and making domiciliary visits, with key workers, has assisted patients and carers with the management of medicines (3).

Method

Following the Derbyshire project, the Mental Health Foundation commissioned a baseline UK survey to identify the level of pharmaceutical support available for older people with mental health problems living in their own homes. A survey design of separate self-administered, semi-structured questionnaires were piloted for the following groups:

123 Community Pharmacy Advisers from all Health Authorities in the UK, 72 Hospital/Trust Psychiatry Pharmacists, 80 CMHTs and 179 Alzheimer's Society branches. The response rates were variable. Hence, the results should be seen as suggestive. Free text data was analysed thematically and nominal data was entered onto a SPSS database.

Survey Findings

Similar percentages, of Hospital Psychiatry Pharmacists (33.3 %), Community Pharmacy Advisers (30.6 %), CMHTs (28.6%) and Alzheimer's Society Branches (36.8 %) stated that they currently had pharmaceutical services for older people, with mental health needs, living in the community. However, over 40 % of hospital pharmacist replies were described as hospital based services. The majority of Community Pharmacy Advisers replied that community pharmacists provided these services but some were for older people in general, rather than specifically for those with mental illness.

The number of respondents having a domiciliary visiting service varied between the groups from 2.8 % (Hospital/Trust Pharmacists Survey), 14.3% (CMHTs), 21 % (Alzheimer's Society Survey) and 31 % for the Community Pharmacy Advisers in Health Authorities. Some of the replies indicated that this domiciliary visiting service was on a time-limited project basis or covered only a proportion of the PCG/Ts in one area. There was a moderate positive response rate (ranging from 22 % to 50 %) for the provision of compliance aids and prescription collection and delivery services by pharmacists. However, these services appeared to be provided by'some' pharmacies for 'some' older people where needed. Both the CMHTs and Alzheimer's Society Branches considered that a domiciliary visiting service, prescription collection and delivery, medication review and the provision of compliance aids to be potentially the most beneficial services for this group of people.

Conclusions

There appears to be low levels of pharmaceutical services, throughout the UK, aimed specifically at supporting older people with mental health needs in the community. The major barrier given was a lack of funding to allow pharmacists the time to be able to develop and participate in these services. However, both groups of pharmacists acknowledged that there was much scope for the involvement of pharmacists in initiatives in these areas.

References

1. 'Forget Me Not': Mental Health Services for Older People, Audit Commission, Jan. 2000.
2. National Service Framework for Older People. Department of Health, March 2001.
3. Harris D. Adherence support and pharmaceutical care for elderly people with mental health problems living in the community. Abstract, HSRPP Conference, April 2000.