Understanding and improving care with medicines provided by pharmacist prescribers for people with mental illness in the community: a sequential multi-method study

Abstract Introduction With rising demand for mental health support, pharmacist prescribing services have been introduced to improve access to care.[1] Yet, little is known about how patients and carers view these services. Understanding their experiences is important as pharmacists’ roles in mental health expand, supported by national policies such as the UK Government’s 10-Year Health Plan for England.[2] Aim This study had two phases: first, to explore the experiences of people with mental illness and their carers with pharmacist prescribing services in the community; and second, to identify and prioritise ways to improve these services. Methods Phase 1 involved remote semi-structured interviews with patients with mental illness and their carers who had received care from pharmacist prescribers (April–September 2025). Phase 2 consisted of three remote consensus building workshops (involving patients/carers and pharmacist prescribers) to identify and rank priority areas for improvement. Phase 1 findings informed idea generation in Phase 2. Participants were recruited using purposive sampling via national networks. Phase 1 data were thematically analysed with independent coding checks; Phase 2 used Nominal Group Technique (consensus methodology). Results Thirteen participants took part in Phase 1. Of these, 10 interacted with pharmacist prescribers in General Practice (GPs), one in both GPs and Community Mental Health Teams (CMHTs), one in Integrated Care Services (ICSs), and one in CMHTs only. Main themes identified were consultation quality, accessibility of services, and awareness of pharmacist prescribers. Within consultation, subthemes included consultation length, holistic approach, medication expertise, collaboration, and communication style. Most participants valued the longer consultations (30–60 minutes compared with 10–15 minutes with GPs), which enabled more thorough and holistic discussions. Patients and carers also perceived pharmacist prescribers as having greater expertise in medications than doctors. However, not all experiences were positive, as some reported limited personal benefit and felt excluded from their own care. From the patient workshop five priority areas were identified: improving mental health training, building ongoing relationships, strengthening collaborative care, developing consultation guidance, and raising awareness of pharmacist roles (ranked highest to lowest). Staff workshops prioritised partnerships with other healthcare professionals, enhancing training, involving patients in decisions, and developing clearer resources and guidelines. Conclusion This is one of the first studies to explore experiences of patients with mental illness and their carers with pharmacist prescribing in community settings, alongside generating priorities for service optimisation. Overall, pharmacist prescribing was well received, with participants valuing longer consultations and a more holistic approach, reflecting the potential of pharmacists to enhance mental health care. Some challenges were identified, including limited involvement in decision-making. Patients and staff highlighted the need to strengthen mental health training, continuity of care, and inter-disciplinary collaboration. A strength of this study is its national reach. A limitation is that most patient/carer participants received care in general practice; future studies should explore other settings to broaden the evidence base.