This article describes New York State's experience in advancing its mental health pharmacy programs. Implementation in a systematic fashion of accountable drug distribution services and basic clinical services is described. The approach used builds upon a firm foundation using a unit-dose system, a prerequisite before progressing with clinical initiatives. This base of activity is then improved by implementing computerization, clinical prescribing guidelines for drug use evaluation, and direct patient involvement with medication education. The planning necessary in order to prepare a unit-dose system is described. Issues considered include staffing estimates, recruitment of a work force, and training of new and existing staff. The problems encountered in implementing change within a large state bureaucracy, as well as the rewards and frustrations of working in this challenging environment, are discussed.
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