Lisa W. Goldstone, associate professor of clinical pharmacy, is an expert in matters of mental health. She has over 25 years of experience working as a board-certified psychiatric pharmacist and a national leader in psychiatric pharmacy. She served as president of College of Psychiatric and Neurologic Pharmacists (CPNP) from 2019-2020, where she worked collaboratively with other health care professionals on increasing access to mental health services and addressing the shortage of psychiatric pharmacists.
As May is Mental Health Awareness Month, here Dr. Goldstone addresses the importance of board-certified psychiatric pharmacists in healthcare settings, how socioeconomic disparities affect mental health, and tips for improving mental health and well-being.
How did you become interested in psychiatric health?
I received my master’s in clinical psychology from Illinois State University and practiced as a psychotherapist for four years before I decided to go to pharmacy school. I have always been interested in psychology and human behavior and I had plans to pursue a PhD in clinical psychology or forensic psychology, however, my plans changed when I became a therapist for teenagers who were involved in the court system. Many of the youth I interacted with had untreated mental health issues and were not well-versed in medication treatment plans. Ultimately, my experience in this role solidified my decision to pursue a PharmD.
Can you share more about your experience as past president of the College Psychiatric and Neurologic Pharmacists (CPNP) from 2019 to 2020?
The College of Psychiatric and Neurologic Pharmacists (CPNP) is a professional organization that represents pharmacists and other healthcare professionals in the specialty areas of psychiatric and neurologic pharmacy practice. As past president of CPNP, I was responsible for moving projects forward and contributing to the development and growth of the organization. I would represent CPNP at the Joint Commission of Pharmacy Practitioners (JCPP) meetings and on the American Psychiatric Association’s (APA) task force on interprofessional collaboration. The most exciting part of my role was witnessing how APA brought representatives from major organizations to discuss the different disciplines involved in mental health. This allowed health care professionals to start strategizing ways to work together to provide quality mental health care for patients.
What role does a board-certified psychiatric pharmacist play in the pharmaceutical care of patients with psychiatric-related illnesses and disorders?
Pharmacists can acquire a board certification in psychiatric pharmacy, allowing them to gain knowledge and experience in providing specialized services for patients with mental illness. Psychiatric pharmacists are responsible for providing optimal treatment plans for patients, educating health care professionals on properly treating mental health conditions, and advocating for better public policies that benefit the lives of people living with mental illness.
Psychiatric pharmacists are crucial team members in healthcare settings because they can provide more comprehensive and complex patient care. They work in all areas such as outpatient site clinics, primary care clinics, inpatient psychiatric units, acute settings, prisons, street medicine, research settings and more.
The need for mental health services continues to grow, but we do not have enough psychiatric pharmacists or psychiatric nurse practitioners in the healthcare field. By 2030, there will be a 32% shortage of psychiatrists – bringing in more opportunities for psychiatric pharmacists to make a difference and maintain job security. I am hoping that organizations like CPNP, APA and JCPP can continue to help bridge the gap and bring more awareness to this need.
What work are you currently focusing on?
I am currently working with Steven Chen, associate dean for clinical affairs and professor of clinical pharmacy, to provide psychiatric pharmacy support for the California Right Meds Collaborative—an initiative that delivers high-impact comprehensive medication management services through a sustainable, value-based payment model. I direct the Psychiatry for Population Health Pharmacists Collaborative (PPHPC), which aims to increase access to mental health services. The goal of PPHPC is to equip non-psychiatric pharmacists with the skills and tools they need to manage low complexity psychiatric disorders such as mild to moderate depressive and anxiety disorders, insomnia, alcohol and opioid use disorders. Along with training pharmacists on how to provide effective treatment for mental health disorders, the collaborative also aims to educate pharmacists on when and how to refer patients to a psychiatric specialist.
Can people stabilize a psychiatric disorder simply with medication alone?
That is a complicated question because it depends on the disease state. For example, if someone has a mild to moderate major depressive disorder or an anxiety disorder, you could treat with medication alone or you could do psychotherapy, but it all depends on the diagnosis and the level of severity.
I always tell my patients that medication will help them while they are taking it, but they also need to learn coping mechanisms and other cognitive behavioral therapy skills as part of their treatment.
Individuals with serious mental illnesses like schizophrenia, bipolar disorder, or severe major depressive disorder need additional services beyond medication alone.
How does stigma affect mental health?
How does it not? Stigma has been around forever. I have been in the mental health field for 25 years now and I have witnessed how the stigma, to some degree, has changed over time. People are becoming more accepting of those who have depressive and anxiety disorders but there continues to be a lot of stigma towards people with serious mental illnesses like schizophrenia and bipolar disorder. To combat the stigma, I have always taught people to use non-stigmatizing language when talking about someone with a mental health disorder. Referring to a person with schizophrenia as a “schizophrenic,” or calling someone with an alcohol use disorder an “alcoholic,” is very harmful. Instead, they should be referred to as a “person living with schizophrenia” or “person with an alcohol use disorder” as they are persons with diseases, not diseased people. Stigmatizing language can deter people with mental disorders from seeking help because they fear they will be negatively judged for their condition.
How do socioeconomic disparities affect mental health?
Social determinants contribute to negative mental health outcomes for patients and hinder their ability to access services. Patients should have mental health parity; an equal treatment of mental health conditions and substance use disorders in insurance plans. Sometimes, patients are interested in receiving psychotherapy, however, it requires frequent weekly visits with co-pays. The high cost of seeing a therapist deters patients from seeking additional services and ultimately leaves them no choice but to choose a more cost-effective solution such as solely relying on medication for treatment.
Do you have any tips for improving mental health and well-being?
I am a big believer in having a work-life balance. I think it is critical that people have a sustainable and reasonable work schedule that allows them time for their personal life such as spending time with friends and family or pursuing other interests that are outside the work environment.
For USC resources on mental health, please visit the following:
USC Student Health: Counseling and mental health programs include individual therapy, group therapy, crisis support, psychiatric services and specialties for gender-based harm.
Service Navigation for Cultural Communities: Support for BIPOC and LGBTQ+ identified individuals.
Care for the Caregiver (C4C): A comprehensive program, in collaboration with the Department of Psychiatry and the Behavioral Sciences at the Keck School of Medicine, designed to ease potential work environment stress for dedicated health care staff. (Contact: CareForTheCaregiver@med.usc.edu)
Support for Work-Life Balance: provides programs, resources, and services to USC benefits-eligible faculty, staff, and post-docs that help them thrive in all areas of work-life wellness.
Project Wellness: USC School of Pharmacy’s initiative is committed to promoting and supporting wellness and well-being efforts for students, staff, and faculty.