Case reports of interprofessional care for clients enrolled in a mental health court

An interprofessional mental health court (MHC) team was created in Milwaukee, Wisconsin, in 2014 to help keep low-level offenders with mental health (MH) disorders out of the correctional system. The focus of MHC is on stabilization of MH disorders and rehabilitation rather than incarceration. A clinical MH pharmacist was added to the team in 2015 to provide expertise on psychotropic medication regimens and to meet with clients for medication education.

A 58-year-old black male was admitted to the MHC after he failed to provide sex registry information. His past medical history was significant for major depressive disorder, schizophrenia, substance use disorders, and seizures. At the time of pharmacy review, medications included aspirin, levetiracetam, risperidone, ziprasidone, and paroxetine. The pharmacist identified 3 potential drug therapy problems (duplicate therapy, potential adverse drug reaction, and inadequate dosage) and sent a letter to his psychiatrist. Risperidone and ziprasidone were switched to aripiprazole, and he was referred to a neurologist. He was eventually terminated from the MHC because of multiple violations. A 34-year-old black male was admitted to the MHC for disorderly conduct and destruction of property. His past MH history was significant for schizophrenia and substance use disorders. He was not taking psychiatric medication upon admission to MHC. While the client was institutionalized for competency determination, collaboration between the MHC pharmacist and psychiatrist resulted in the prescribing of a long-acting injectable antipsychotic, which the client was stabilized on. He subsequently graduated from the MHC.

Clinical MH pharmacists play a key role on MHC teams by providing medication education, identifying drug therapy problems, and communicating with the clients' medical providers. Lack of access to medical records, court schedule conflicts, and collaboration between interprofessional groups that historically have not worked together are challenges to a pharmacist working on an MHC team.