Curious about the pivotal role pharmacists play in mental health care? Tune into Level Up host Ashlee Klevens-Hayes' enlightening conversation with Amy Werremeyer, a board-certified psychiatric pharmacist, tenured professor & chair of pharmacy practice at North Dakota State University, and tireless advocate for people with mental health and substance use disorders. Hear about her inspiring leap from inpatient psychiatry to her current role in a community mental health center, where she is dedicated to not only prescribing but educating patients about their medications and providing realistic expectations and coping tools.
The second half of our chat dives into the rising demand for specialty pharmacists in the mental health sector and the opportunities that arise with this shift. Amy enlightens us about the potential of improved medication management and non-pharmacological therapies. Her extensive knowledge and passion make her insights on the future of pharmacy in mental health invaluable. From creating access to improving the quality of care, this episode promises to deliver resources, tips, and personal anecdotes that can educate and inspire. Don't miss out on this exploration of mental health in pharmacy with Amy.
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For more info on our upcoming live course 'Illuminating the Darkness: Depression Guideline Update', visit ceimpact.com.
2023 ASHP Forecast
American Association of Psychiatric Pharmacists
Amy, welcome. To Level Up, I'm super excited to talk to you. You have great reviews internally on CE Impact. Everyone was super excited to work with you and, of course, we have your live CE coming up in a couple of weeks, so I'm really grateful for the opportunity to connect and welcome to our show. Thank you, pleasure to be here. Yeah, we are gonna be focusing on mental health, specifically guiding us and teaching us on your role in your setting and what you do for pharmacy at large with the Psychiatry Association, and then also just what you do in the field or in the community. So I'm super excited. Welcome to our show. Why don't you just start up with sharing a little bit about your background, what you do on a day-to-day basis and the patients you serve?Speaker 2:
Okay, so I'm a board certified psychiatric pharmacist and I'm also a tenured professor and chair of the pharmacy practice department at North Dakota State University, so that means that I wear quite a few hats. I have about 17 years of practice experience in various psychiatric treatment settings. I spent the majority of the first part of my career so well over a decade on an inpatient psychiatry unit working with patients of all different types of mental health and substance use disorders and was part of an interdisciplinary treatment team that did treatment planning for patients when they were admitted. So I did a lot of consultation work, a lot of drug information provision and tons of patient education. I would go into a room with 12 or 14 patients with psychiatric disorders of all different types and just field their questions about their medications and try to provide answers in ways that were true to what we know about the science, but also in layman's terms, so they can understand and implement things once they left the hospital in terms of adherence and kind of even acceptance of their patients.Speaker 1:
Sure, sure, well, that's so many people that I'm interviewing on this podcast, because it's relatively new. They were doing such radical things. So every time I hear what the guests are doing, what people are doing, I'm always like, oh my gosh, here I am just doing marketing and you guys are out there changing, making direct changes to patients, and I mean that is an incredible role. So how did you transition from that role to what you're doing today?Speaker 2:
So today I'm in a close-up clinic at a community mental health center for patients who are indigent typically, and I transitioned out of the hospital and actually went through a whole year without practicing, right at the start of the pandemic, and then I actually reached out to the community mental health center because I was like I don't wanna be teaching pharmacy school and teach pharmacy students about psychiatric pharmacy if I'm not doing it anymore. It just didn't feel good at all. Plus, I love caring for patients. I love working with patients. I feel like I learn as much from them as they might learn from me, and so that two-way street is something that I really missed and was really willing to do. So it's really nice that I'm in academia so the clinic doesn't have to pay me, so I can be there as a consultant and I work with the psychiatry residents who are the prescribers for close-upine in that clinic and then I do a lot of like drug information for them, helping them manage some of the non-psychiatric medications that might be on the person's regimen when they're adjusting psychiatric meds too.Speaker 1:
Right, so are you working with medical residents?Speaker 2:
Well, yeah, they're residents that are, so they already have their MD. They're gonna be psychiatrists.Speaker 1:
Okay, so psychiatrist medical residents. I wasn't sure if you work with pharmacist residents too.Speaker 2:
Not now, except for in a mentoring them for teaching capacity. Sure, okay, got it okay.Speaker 1:
So how did you land in this mental health, this whole umbrella expertise that you're in now?Speaker 2:
It was sort of serendipitous, honestly. When I was an undergrad I was a triple major in chemistry, biology and psychology, mostly just because I was kind of interested in those things. But then when I graduated from pharmacy school, I did a residency and I knew I was kind of interested in academia, but I was thinking more cardiology, honestly. And then during my residency I found out that the position that I'm in now was being vacated. The person who had been in it for a long time was retiring and I was talking to one of my mentors about the position and the person who'd been in it for a really long time, who I really admired, and I was like who are they gonna get to fill that position? And my mentor was like, why not you? And literally that question changed the course of my life because I then was able. Back then PGY1 residencies were not nearly as structured as they are now, and so I was able to do four more months of psychiatry than when I was a PGY1. And the rest is history kind of. I've just been involved with and had a passion for caring for patients with psychiatric disorders ever since, and I always tell people that I feel like in a lot of areas of life, I have a tendency to kind of root for the underdog, and I feel like people with mental health and substance use disorders in so many ways, because of the way our society and our healthcare systems and everything are set up, people who have mental health disorders often end up being underdog a lot, and so I really feel like it's a great opportunity to be able to empower people advocate for them, come alongside them, all that kind of thing. So it's very rewarding.Speaker 1:
Yeah, and you. It's funny that you bring up the underdog because before we started recording, you shared with me about your foster failure. Your dog, yeah, yeah. So it's a very serendipity. Speaking of serendipity, you do root for the underdog by like fostering and then you kept this dog. So I love that story, I love it. Okay, so share with us what you think the pipeline consists of for pharmacy and the mental health space, Like where do you envision us going and you know where are we today versus where do you think we're going?Speaker 2:
Yeah. So that's a really complicated question, but one that I think is going to see a lot of dynamic changes over the next few years. I don't know if you're familiar with the ASHP pharmacy forecast, but they do a panel analysis of kind of what are trends and where do we expect to see things in pharmacy, especially health system pharmacy, but beyond that, also in the next five years, and the most recent release of that work, the 2023 pharmacy forecast, 79% of the panelists agreed that the demand for pharmacists, advanced training and mental health will likely increase for the next five years. 79%, and then 63% said they did not think that health systems are currently prepared to meet the increased demand for psychiatric service provision in the pharmacy or in their pharmacy enterprise right at this point. So I think there's going to be a lot of growth or at least a lot of demand. Whether we can supply the resources that are needed to meet that and achieve that growth, I don't know. I'm a little concerned, honestly, because I feel like the training that is given for generalist pharmacists in pharmacy school is a great foundation, but until you, I think, get some experience, or at least maybe get some mentored experience in caring for patients with psychiatric disorders. We know that there's just a lack of confidence upon the part of pharmacists who haven't gotten a little bit more training in this area. So I think there's tons of opportunities. So it's really exciting.Speaker 1:
I just hope we can capitalize on it and really step up to help care for people and meet the demand that ASHP survey was specifically, obviously because they're geared towards health system and pharmacy practice. So that's mostly. We're talking about inpatient growth, right? So there's a shift.Speaker 2:
Well inpatient or M-Care, because ASHP focuses on ambulatory care as well. Okay, so many health systems have clinics that are you know.Speaker 1:
True, true, true. And so where do you think, wow, that's huge. So where do we think that this mental health crisis is coming from? Not that that really pertains to pharmacy so much, but in general, where is the large uptake coming from, or the large growth?Speaker 2:
I think so you're asking the growth in the population From the patient population. Yeah, well, I think the pandemic created issues in so many ways, both with access to care and then social isolation and kind of breakdown of the way society operated. You know, that created a lot of challenges for people who already had mental health conditions. The control of them became worse, but then also it created a lot of anxiety and a lot of fear and a lot of depression for people who hadn't previously experienced those things, and then they also didn't have great access to care. During the pandemic we also read a lot about the impact of social media and its kind of impact on self-esteem and self perception, and that can contribute to a lot of increases in depression and anxiety as well, and substance use disorders too. The same goes for those conditions as well.Speaker 1:
So we're thinking, the uptake, that large percentage, the need or the demand for taking care of these types of patients is what type of patients are they? I mean, are they having what requires an inpatient or an ambulatory care visit? These types of patients.Speaker 2:
It's pretty across the board. They're patients with really any mental health condition you can think of. Substance use disorders we know are very under treated. Something like 70% did not get treatment for opioid use disorder when they when it was indicated for them in the last year or two. So there's a huge gap in what is needed and what can be provided, or maybe in some cases it's even what patients are seeking. You know, sometimes they're not seeking care, but they probably really need it. So there's work to be done on opening the doors for people so they feel like they can come in and get care, and that has to do with reducing stigma. We know that stigma on the part of healthcare professionals is a really big barrier to help seeking behaviors by patients. So I think we need to get the message out that we're welcoming and we're not gonna judge people and we're gonna meet them where they're at and we're gonna walk alongside them and help them whatever way we can.Speaker 1:
Yeah, that's. I mean, that's a loaded, that's a loaded task. I mean, even amongst the healthcare professionals there's a stigma.Speaker 2:
Yeah, mental health issues amongst my research areas actually is stigma toward mental health and substance use disorders on the part of health care professionals.Speaker 1:
Really. What tells more about that? What does that entail?Speaker 2:
So in some of the work that we've been doing with opioid use disorder prevention and we're working on kind of upstream interventions at the community pharmacy level so that anybody who comes into the pharmacy with an opioid prescription, the pharmacist has a conversation with them, screens them for their risk for opioid harms down the road and then educates them about. You know, because you have these risk factors in your background, you're actually at higher risk of developing opioid use disorder, and so we want we want pharmacists to be empowered to impact the relationship that a person has with an opioid right from the time they first encounter an opioid, so that they're aware of what could happen and how they can prevent that from happening. So, as we've educated pharmacists to do that, we've also built in some stigma assessment and stigma reduction content and we've found I mean, the literature is filled with examples like this, I'm only speaking about pharmacy right now, but that pharmacists and other healthcare professionals do carry a stigma about, especially substance use disorders, but other mental health conditions as well. But it's modifiable and once they gain experience with, for one, how to communicate non judgmental ways, even some of the words that they use, how those can come across and make people feel distanced from them they. It can be very impactful then to those people just thinking about the way that they talk and kind of some of their intrinsic reactions when they work with people and modifying those, how much that really helps create relationship and helps them feel like they're able to create a more welcoming environment for the patients that they work with.Speaker 1:
Right, I know that you are doing the depression guideline updates for our pharmacists by design membership in the couple in the next couple weeks. I'm just curious in these guidelines do they talk about those types of word phrases, or is it mostly like a clinical guideline?Speaker 2:
This guideline was very clinically focused and did not talk much about stigma at all, but the shatter proof site and movement I don't know if you're familiar with shatter proof they have a lot of resources about stigma, free communication and non judgmental approaches to patient care and things like that, so it's a really good resource if anybody's interested.Speaker 1:
Yeah, we can link that in the show notes for sure. What do you think? Okay, so do you think that the role of the community pharmacists can shift alongside of this large demand for a shp type pharmacists, or inpatient or ambulatory care pharmacists?Speaker 2:
Absolutely, and I would even argue that our profession is obligated to see how we can do that, how we can shift that role a little bit. One of the things that I talked to my students about when I'm teaching them about antidepressants especially, is that those medications are they're challenging to take for patients. They often feel worse before they feel better when they start taking an antidepressant. This is such a key person who can help educate the person, the patient, about what this is going to be like. Give them realistic expectations about what an antidepressant is going to do in the short term and versus the long term, because those are two very different things. Help coach the patient through the time at the clinic where it takes a long time for the medication to start working. Give them tools to cope while they're waiting. I mean it doesn't have to be that the pharmacist is an is an expert in those trees, but in at least provide some resources, including things like digital health tools that are an app to help manage major depressive disorder symptoms and track them. You know that you're fine.Speaker 1:
The even amongst our own profession, there's a stigma that no one has time, or there's the issue, not even just the stigma sorry, I should not say that. It is not a stigma. It is a fact of well researched that pharmacist in the community really struggle with time management and they're just pushing and or trying to get the prescriptions out the door. And so I'm just curious, you know, do you come across pharmacists that struggle with that? They want to coach? But there's this, is there enough time? That's the issue, right.Speaker 2:
Yeah, I totally hear that argument and my dad has been a community pharmacist for 45 years or so, so I've worked in and around community pharmacy since I was a little kid actually. But I guess I would argue and this is easy for me to sound philosophical about this but I mean, we went into this profession, all of us, in order to help people and become a resource for our patients, and so I would challenge us all to prioritize that whenever possible and I know that's not always possible, but whenever it is that that is something we should prioritize in connecting with our patients, helping them understand what to expect from their medications. And if you think about it in a business sense, if someone is starting on an antidepressant and they're filling it at the pharmacy, paying their copay, et cetera, and it goes badly and they don't like how they feel on it and they stop taking it in the first three weeks of that, they you know that they're supposed to have been taking it longer. That's less of income for the pharmacy too, if they don't come back to refill the prescription repeatedly. You know so there can be ways to build in that coaching so that it is helping to grow the bottom line as well.Speaker 1:
No, you're not wrong. I mean, if someone isn't feeling an effect, or it's helping or actually the opposite, it's making them feel worse, the likelihood of them coming back for adherence or for return, assumingly, is low, right, exactly. So it's kind of putting in the upfront discussion, the upfront coaching, having those tools to communicate and build that relationship and build that trust with the patient. That's so. That's a unique experience in itself and can prevent further issues down the road, but also for an incentivizing each patient to come, to come back Right. Talk to us a little bit about the American Association of Psychiatric Pharmacists. I know that you've mentioned that you're the president. So what is that? What is that organization, what are the goals there and what do you do as president?Speaker 2:
Sure. So the American Association of Psychiatric Pharmacists is the national professional home for psychiatric pharmacists and we have members that are board certified psychiatric pharmacists and also members that are not board certified psychiatric pharmacists, and we focused on best equipping psychiatric pharmacists and the profession of psychiatric pharmacy to help to create access and improve quality of care for patients with mental health and substance use disorders. What do I do as president? It seems like I attend a lot of meetings and interact with a lot of members, and some of the things that we're focusing on now are advocating for some of the things I've just been talking to you about, as far as the importance of the role of a pharmacist being part of every patient's care who has a mental health or substance use disorder, in order to provide that coaching and realistic expectations and scientific management, information and all that kind of stuff, so that, in the end, the outcome for that person can be better. And there's data that show that that's the case when a psychiatric pharmacist is involved, that outcomes are better, and it's a lot of we're having a lot of conversations with people at the national level groups as well as regulatory groups SAMHSA and Center for Medicare and Medicaid Services as well to try to tell that story and kind of remind those groups that by not paying pharmacists the competitive rate that they might deserve for doing this kind of work and improving those kinds of outcomes, we're actually lowering outcomes overall. Right.Speaker 1:
Thank you. So you are coming back to CE Impact in a couple weeks, which we are really excited to have you participate in. The live CE Tell us a little bit about, like a glimpse of, what you're gonna be sharing. So this depression guidelines. Is this an annual update?Speaker 2:
No, I don't believe it is. I think it's a release of a more updated literature review over the last I couldn't even tell you exactly how many years, but I would say it's probably at least five years of review, and it's got a fair amount of information about making antidepressant choices for patients. So if they've been they're new to antidepressants what might we consider? What are the evidence-based options? If they have started on an antidepressant and that's not getting them to remission, then what might be the options for their next steps in terms of modifying their antidepressant therapy?Speaker 1:
And it includes some recommendations about non-pharmacologic therapy, as well, awesome, yeah, I mean, obviously, there's a huge pipeline opportunity for us coming out of the pandemic and making sure that our clinicians are up to speed and up to date on what's available in terms of medication management and also non-pharmacologic issue non-pharmacologic resources too. So I think this is a great win-win for pharmacists who are looking to up level their, their mental health medication management side. So I'm super excited to have you in. I know the team is really looking forward to this kickoff. We've been talking about this internally for a couple of months now and we are really excited to have you. Awesome, thank you. Yeah, thanks for your time, and I'm gonna link all the show notes or all of the different areas we talked about today, so any resource will be available in the show notes and a way to message Amy, and I appreciate your time, amy.Speaker 2:
Thank you, it's really great to meet you Ashley.Speaker 1:
Yeah, you too take care.