COVID-19 has intensified the “mental health pandemic,” said Julie Dopheide, PharmD, BCPP, FASHP. What’s worse is that access to mental health care continues to be a challenge for individuals. Dopheide and coauthors of a new paper published in Child and Adolescent Psychiatric Clinics of North America believe that clinical pharmacy is underutilized within the mental health space. In the paper, the authors share how clinical pharmacists and psychiatric pharmacists can improve care for children and adolescents with mental health diagnoses. “Youth are increasingly prescribed psychiatric medications, and they are vulnerable to drug interactions and adverse effects and need special monitoring and education on the benefits and potential risks of psychiatric medication,” said Dopheide, who is a professor of clinical pharmacy, psychiatry, and the behavioral sciences at the University of Southern California School of Pharmacy and Keck School of Medicine in Los Angeles. Dopheide said job opportunities for mental health pharmacists, particularly BCPPs, are increasing nationwide. BCPS and BCACP pharmacists also have a role in mental health, she noted. “Mental health settings are inherently multidisciplinary and psychiatric treatment teams are very open to clinical pharmacy,” said Dopheide. While some psychotropic medications are prescribed off-label to youth, many commonly prescribed medications have been studied in this age group with clear labeling on dosing and monitoring to ensure they can be given safely. “Pharmacists need to actively stay abreast of which psychiatric medications are the most well-studied in youth so these can be recommended over off-label, less well-studied mental health medications,” said Dopheide. A 2015 study from the Office of the Inspector General (OIG) on youth prescribing of antipsychotics in 5 states found that two-thirds of the 485 medical records reviewed demonstrated quality-of-care concerns, including poor monitoring (53%) and inappropriate treatment (41%). OIG and FDA even warn that children and adolescents need metabolic syndrome monitoring when prescribed antipsychotic medications. Research has found higher rates of sedation, weight gain, tachycardia, and agitation in youth given psychotropics compared with adults. Not only does evidence point to an increased risk for type 2 diabetes in youth taking antipsychotics, but emerging evidence suggests this is also the case with SSRIs given to youth. However, some county and state mental health departments are waking up to this and partnering with pharmacists to improve medication therapy monitoring. Several states—including Texas, Indiana, and California—have published pediatric psychotropic guidelines or practice parameters developed through collaborations between child psychiatrists and psychiatric pharmacists to elevate the quality of care for children and adolescents. Many states include child psychiatrists collaborating with pharmacists on Medicaid pharmacy and therapeutics committees and drug utilization review boards to improve medication safety. Clinical pharmacists are not regularly involved in mental health treatment teams even though they’ve been able to improve the quality of care for patients. “While medication management is an important component of the care plan, unfortunately, due to limited resources for mental health, the pharmacist is often not included in the mental health care team,” said Debbie Lu, PharmD, MPH, lead author of the paper and assistant professor at Touro University California College of Pharmacy. Psychiatry teams are more likely to hire therapists or case workers as their allied health staff. However, there are health systems, such as Kaiser Permanente, that have benefited from having dedicated mental health pharmacists on the team. The paper presents case studies in different settings to show how a collaboration with a psychiatrist and pharmacist can work in real life. “A psychiatric pharmacist can review medication administration records and screen for drug interactions to discuss with the child psychiatrist and child fellows,” said Dopheide. “The psychiatric pharmacist can participate in daily treatment planning to bring up pertinent drug therapy issues, such as the need for monitoring for metabolic syndrome or hyperprolactinemia with antipsychotics.” Another common way child psychiatrists and clinical pharmacists collaborate is through medication groups for patients and families. Also, interpretation of genetic tests and creation of pediatric guidelines for psychiatric medications is another “real-life” way these providers can collaborate. Payment for these services remains a challenge for pharmacists, but Dopheide said health system administration can justify paying for a psychiatric pharmacist through improved medication outcomes, like better adherence, follow-up, and prevention of adverse drug reactions or interactions. “In many health systems, billing for medication groups and medication reviews is a way to pay for integration of psychiatric pharmacists,” Dopheide said.