Expanding Access and Expertise: How Psychiatric Pharmacists Can Bridge Behavioral Health Gaps

In this interview with Pharmacy Times®, Jolene Bostwick, PharmD, BCPS, BCPP, and Brenda Schimenti discuss the essential role of board-certified psychiatric pharmacists (BCPPs) in addressing behavioral health workforce shortages, particularly for complex patients and underserved populations. Bostwick highlights the proven effectiveness of BCPPs in improving outcomes and reducing health care costs through expert medication management while emphasizing the importance of continuing education, active involvement in professional organizations, and ongoing research to stay current with evolving treatments in psychiatric and substance use care. Schimenti raises concerns about recent legislation that could reduce Medicaid funding, potentially worsening access to mental health services for vulnerable populations.

Pharmacy Times: How might increased involvement of BCPPs help alleviate the current behavioral health workforce shortages, notably in underserved areas or for “complex” patients?

Jolene Bostwick, PharmD, BCPS, BCPP: I'm really glad you asked this question because the behavioral health workforce shortages are a tremendous concern. As I've maybe said already, BCPPs are very experienced in managing complex cases, including those that involve treatment resistance or polypharmacy, we can manage medication regimens to reduce hospitalizations and improve quality of life. This is all critical because we know that the patients living with serious mental illness have 2 to 3 times greater mortality rates, higher risk for cardiovascular disease and related death, frequent medication nonadherence that can cost $30 billion annually in additional health care expenditures, and when medications are not optimized, this can add an additional $500 billion annually. In my view, as part of the health care team, psychiatric pharmacists can significantly reduce these additional healthcare expenditures.

The VA is a great example of the role and impact of psychiatric pharmacists, from depression to schizophrenia and substance use disorder treatment and more. From their Fiscal Year 2023 report for the clinical pharmacist practitioner role in mental health fact sheet, they found that there were 583 clinical pharmacist practitioners in mental health at 140 VA facilities, and during fiscal year 23, there were nearly 500,000—that's half a million—patient care visits that were delivered by mental health clinical pharmacist practitioners. By seeing all these patients, we're increasing the capacity for prescribers to really concentrate on their important roles that are less focused on medication use.

As the medication experts, BCPPs have the training, knowledge, and skills to expand access to care through methods like telehealth to reach those patients who are underserved or in remote areas and through collaborative practice agreements, as we previously discussed. Many of us also are participating in research and engaging in advocacy to help disseminate our value for recognition for payment for our services, which Brenda talked about, and provide quality care for our patients.

Pharmacy Times: How do BCPPs stay current with the rapidly evolving pharmacotherapy for psychiatric and substance use disorders?

Bostwick: Practical education…AAPP, our organization, one of our foundations and our missions is education. And so, one of the avenues we have for that is our annual meeting and lots of [continuing education (CE)] over the years and webinars and presentations to continually refresh and expand our skills. We've had a lot of sessions on psychedelics; you give a great example. So, we have a summit every year that has like hot topics that are just fresh and exciting that we need to know about to provide the best care for our patients and be at the top of our game. So, definitely just education, of course, CEs for our certification for board certification or our state licenses. And just like any other pharmacist, you know, keeping up on the literature through our regular review of important publications like Pharmacy Times and clinical guidelines related to practice.

And then one of the big things, of course, is just active involvement in professional organizations, doing research, and teaching and mentoring to help us all stay abreast of current issues, trends, and new treatments—both pharmacologic and nonpharmacologic—and involvement in professional organizations is really vital to engage as a community for us both within our profession and also outside so we can learn from each other due to all the complexities of psychiatric care.

Pharmacy Times: Has recent legislation impacted BCPPs, patients, and the psychiatric space?

Brenda Schimenti: You raise a really good point, because as we're speaking [at the time of this recording], the “Big Beautiful Bill” is up reconsideration back in the House, and should the cuts to Medicaid occur that are anticipated, it's certainly going to be very problematic for patients with mental health and substance use disorders. There's certainly a huge percentage of patients living with those disorders that have Medicaid as their source for insurance and care, so, should those services be cut, we do see that those individuals are going to have a very hard time continuing their treatment or receiving treatment, which we already know there's a huge access issue. So, access to care, I think, is going to be heavily impacted in the current environment.

Bostwick: That's a big thing. We're really worried about the care and treatment of our patients.