One in four people in the UK will experience a mental health problem at some point in their lives and each year more than 250,000 people are admitted to psychiatric hospitals.
Many people receiving care from specialist mental health services are prescribed one or more psychotropic drugs. There is good evidence for the effectiveness of these drugs and a body of authoritative guidance about their use. However, prescribing practice varies greatly and frequently departs from best practice.
If patients are not prescribed medication in line with best practice, they may not obtain the full benefits of the medication, may be less likely to follow the correct course of medication, experience more avoidable side effects and their condition may be more difficult for a doctor to assess. In extreme cases, this situation can lead to more cases of severe, long term illness and even death.
The Prescribing Observatory for Mental Health (POMH-UK) was set up in March 2005 to help mental health services monitor and improve their prescribing of psychotropic medicines in relation to known best practice, such as Healthcare Commission Standards for Better Health and National Institute for Health and Clinical Excellence (NICE) guidance.
Getting involved
So far, 40 mental health trusts across the UK have been recruited to take part in the programme. Its first two projects included audits and quality improvement interventions to reduce the prescribing of high-dose and combination anti-psychotic medicines and increase the screening for metabolic side-effects of anti-psychotic medicines across the UK. Data collection was web-based, allowing participants to input data online and to compare their practice against other trusts.
Mary Cavanagh is leading the project team based at the Royal College of Psychiatrists. “The Health Foundation award has given us a great opportunity,” she says. “The funding has enabled us to establish this new programme from scratch, including the vital infrastructure.”
Dr Andrew Blewett, a consultant psychiatrist in mental health at the Devon Partnership Trust, also works on the project. He says that variations in prescribing can be hard to see locally because most mental health trusts have only one pharmacist who may be under resourced to audit prescribing patterns. He adds that the project shows the potential for pharmacists to really get involved in quality improvement in mental health trusts.
The patient perspective
Patients have a key role to play in the programme: most participating trusts have recruited at least two service users to their project teams. Mo Hutchison is a service user consultant on the central project team based at the Royal College of Psychiatrists. Her role is both to ensure that the patient perspective is taken into account by the team and to liaise with other users. “It’s important for service users to be involved because they have a unique perspective, they’re on the receiving end of medication,” she says.
“In the ideal world, more care would be taken in the prescribing of mental health drugs,” she continues. “I don’t think psychiatrists take all the factors involved into account when they prescribe, or take account of the impact that medication has on people lives.”
Mo highlights the work the team is doing to make sure that patients’ physical health needs are taken into account. Some anti-psychotic medications can have adverse side effects such as stiffness. “We’re hoping to produce a small appointments card that encourages people to look after their physical health and go for checks,” she says.
Practice makes perfect
The next stage in the project is to draw out lessons for quality improvement from the data collected. At regional workshops, clinicians from participating mental health services will compare data from different wards and services, such as those in the table below. They will look at the differences between those that are and are not meeting best practice guidelines and use this information to draw lessons for improving performance, which they will then take back to their trusts and implement.
Other innovative methods the team has introduced include mechanisms for involving health professionals in the project. These include training events for pharmacists and clinicians, a slide set with speaker notes for local champions to present the audit results and posters and sticker alerts for patient case notes.
01 December 2006