Psychiatric Pharmacists Are Key to Expanding Access to Care, Improving Outcomes

Amid dual mental health and substance use disorder crises, board-certified psychiatric pharmacists can address shortage of behavioral health providers, USC expert writes in Psychiatry Online.

The U.S. is currently facing a mental health and substance use disorder crisis, with approximately one in five adults experiencing a mental health condition annually, and less than half of all patients with a psychiatric disorder receiving treatment.

Meanwhile, the U.S. has a severe shortage of behavioral health providers. What can be done to alleviate this problem?

In a May 4 article published in Psychiatry Online, Lisa W. Goldstone of the USC School of Pharmacy and co-authors outline a solution: board-certified psychiatric pharmacists can be more extensively leveraged as a collaborative solution to the mental health and substance use disorder crises in the United States.

“Optimizing collaboration with BCPPs could be a critical part of the solution to improving U.S. mental health care,” writes first author Lisa W. Goldstone, associate professor of clinical pharmacy at the USC School of Pharmacy and president of the College of Psychiatric and Neurologic Pharmacists (CPNP). “As this specialty continues to grow, the involvement of BCPPs in care can be optimized to meet the common goal of expanding access, improving outcomes, and minimizing costs of care.”

A highly-trained, recognized pharmacy specialty

In existence for about five decades, the psychiatric pharmacist profession became a recognized pharmacy specialty in 1992. Today board-certified psychiatric pharmacists are clinically trained doctors of pharmacy with specialized training in psychiatric pharmacy and patient care. Many have completed two years of postdoctoral residency training and have subsequently achieved their board certification through rigorous examination.

“BCPPs are often underutilized,” Goldstone writes. “This lack of utilization results in lost opportunity to better address the needs of persons with psychiatric or substance use disorders and to meet these needs in a timely manner.”

Most BCPPs consult with psychiatrists or other physicians or health team members and work directly with patients. Similar to physician assistants and nurse practitioners, BCPPs have collaborative roles with providers as part of team-based care, providing medication management and monitoring for potential adverse drug reactions and interactions in a myriad of clinical settings such as hospitals, clinics, and assertive community treatment teams.

Five key areas where BCPPs can be especially impactful, the study authors write, are opioid use disorder, antipsychotic use among children, long-acting injectable antipsychotics, clozapine use, and transitions of care and care coordination. Additionally, pursuant to scope-of-practice laws and regulations governed by the states, BCPPs can perform patient assessments; order and interpret medication therapy–related tests; evaluate and manage disease states; initiate, adjust, and discontinue medication therapy; and refer patients to other health care providers. As with physician assistants and nurse practitioners, these duties are performed in collaboration with a diagnosing prescriber.

One challenge, study authors note, is how best to educate physicians and team members about the advanced training of a BCPP and how it may differ from those of other pharmacists who play very different roles in the health care system.

“Better expansion, education, and outcomes studies illustrating the BCPP’s value could help advance the opportunity for inclusion of the pharmacist in billing models such as value-based care to pay for the services they provide,” Goldstone writes.

About the study

In addition to Goldstone, study authors include Deanna L. Kelly of the University of Maryland School of Pharmacy and the Maryland Psychiatric Research Center, Baltimore.