Pharmacy practice in psychiatry

Professor M Lynn Crismon received the 2021 American Society of Health System Pharmacists award for excellence in pharmacy practice leadership. IMI spoke to him to find out more about his work in psychiatry, psychopharmacology and the US Public Health service.

Professor Crismon served as Dean of the Pharmacy School for 13 years until Autumn 2020 but now he is able to spend more time teaching. This includes teaching psychiatry, clinical psychology and pharmacotherapeutics to Pharm D students and also teaching in the child and psychiatry fellowship program in the Department of Psychiatry.

He argues that there are good reasons for pharmacists to specialise in psychiatry. “Mental disorders are extremely common and they create a lot of the morbidity, pain and suffering that people have throughout their lives. And, of course, severe mental disorders are also associated with the risk of suicide. Medications are one of the primary treatment modalities for mental disorders and so it just sort of makes it ideal that pharmacists would be involved – particularly pharmacists who really enjoy interacting with people and communicating”, he explains.

During the 1990s he was able to use his specialist knowledge and expertise to develop evidence-based protocols to improve outcomes from drug therapy – something that was known as the Texas Medication Algorithm Project.

The project started when the Texas State Department of Mental Health called together chairs of psychiatry from all the large academic psychiatry programs and their associate directors for research; he was “the token pharmacist”. At the meeting they discussed the challenges that existed in state-sponsored mental health care and the fact that it took so long for the evidence from research to get into clinical practice. In fact, pharmacotherapy and all the other services were substandard in public mental health care because funding was so limited, he recalls.

“We didn’t have enough money to be able to address all the issues that existed in public mental health care but we thought we had enough money to address a specific issue and since a number of us had a real interest in pharmacotherapy and really severe mental disorders we decided to focus on evidence-based practices to improve outcomes from drug therapy treatment of individuals with severe mental disorders and to give the psychiatrist the support systems that he or she needed so that they could provide better care for those patients”, he explains.

Traditionally psychiatrists have assessed patients by interviewing them and getting an overall sense of how severe their symptoms are, but there was increasing evidence at that time that measuring and quantifying the symptoms then better outcomes could be achieved. Using a structured assessment enabled clinicians to detect symptoms that might not have been apparent if general, global questions had been asked.  This approach – systematising the information and providing an overall framework for the pharmacotherapy component of care – was a major part of the initiative.

In addition, they involved mental health consumers to help identify the needs that families and patients had in in relation to their mental disorders and their treatment.  Educational programs using a variety of learning modalities including written materials, videos and pictorial methods were developed to help patients and their families.

M. Lynn Crismon is the Behrens Centennial Professor of Pharmacy and Professor of Psychiatry at Dell Medical School at the University of Texas at Austin. His specialty area is psychiatric pharmacy and clinical psychopharmacology.

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