Pharmacists could help curb the mental health crisis – but they need more training

Chances are you live within 2.5 kilometres of a community pharmacy and visit one about every three weeks^[1].

You don’t need an appointment. The wait time is usually short. These factors make pharmacists highly accessible^[2] healthcare professionals^[3].

Pharmacists are regularly sought after for advice, including about mental health. In fact, pharmacists may be among the first^[4] health professional contacted about a health concern^[5]. They are also in regular contact^[6] with patients experiencing mental health issues or crises.

Despite the fact most pharmacists believe it is part of their role to provide mental health-related help^[7], they may lack the confidence^[8] to respond to, raise or manage^[9] mental health issues with patients. In our recent study, pharmacists report not intervening about 25% of the time^[10] when they believe a patient is experiencing a problem or crisis.

Providing pharmacists with early intervention skills could help them address these challenges.

Read more: Pixels are not people: mental health apps are increasingly popular but human connection is still key^[11]

The pandemic has seen mental health decline

The COVID pandemic has seen anxiety and depression increase by 25%^[12] globally, signalling a broader mental health decline.

Poor mental health affects around 20% of the Australian population^[13] each year, and 44% of Australians^[14] over their lifetime. In a recent survey^[15] of 11,000 people, 24% of them said their mental health had declined over the previous six months.

Most concerning is that about 60% of people experiencing a mental health issue won’t seek help^[16]. This means people are more likely to remain undiagnosed and disconnected from support.

Pharmacists’ many hats

While dispensing and consulting are critical activities for pharmacists, they also help patients with questions and advice about their health, including their mental health.

Generally, pharmacists in Australia^[17] have high levels of mental health-related literacy and evidence-based treatments^[18].

Despite this, pharmacists report a lack of confidence^[19] which prevents them^[20] from raising mental health issues with patients. This is possibly because only 29% of pharmacists in Australia have mental health crisis training^[21].

A lack of confidence in raising and addressing mental health-related issues means patients are likely to remain undiagnosed, untreated, and unsupported.

Read more: Scared of needles? Claustrophobic? One longer session of exposure therapy could help as much as several short ones^[22]

4 key elements of mental health first aid

Many of us are familiar with first aid as immediate help offered to an injured or sick person. But what if the issue is not physical, but mental? Many people don’t know what immediate help they can offer.

As with physical injury or illness, timely and high-quality immediate help is critical.

There are a variety of not-for-profit and commercial mental health first aid training programs. A recent literature review of programs for mental health professionals suggests they can minimise stigma^[23] and increase knowledge^[24]. They can also bolster confidence^[25] and intentions to help^[26].

Across the programs, there are four common elements to providing high-quality mental health first aid.

1. Recognise someone may be experiencing a mental health issue or crisis

Recognising a mental health issue or crisis involves taking notice of verbal, physical, emotional and behavioural indicators. Given pharmacists interact with patients about every three weeks, they may be in a good position to notice changes.

They may express sadness, anger, frustration, hopelessness, shame or guilt. Patients might say: “There’s no hope” or “I can’t go on like this”.

Physical indicators include fatigue, sleeping difficulties, restlessness, muscle tension, upset stomach, sweating, difficulty breathing, changes in appetite or weight.

Emotional indicators reflect how a person is feeling and include significant mood changes, teariness, agitation, anger, desperation or anxiety.

Symptom guides^[27] for anxiety, depression, bipolar disorder, and suicidal ideation are available.

2. Approach and assesses the person

Opening the dialogue can be as simple as, “How are you? I have noticed [symptoms] and am concerned.”

Your role is not to clinically diagnose a patient; however, it is valuable to assess the patient’s risk and level of urgency. Risk and urgency will help inform whether the person is in immediate danger or can use other non-urgent support services.

The TED acronym can guide first discussions in the following way:

Tell me …

Explain how that has been impacting you …

Describe what is happening …

3. Listen in an active way and communicate without judgement

Active listening^[28] involves confirming you are hearing and understanding the other person. Ways of doing this include^[29]: nodding, appropriate eye contact, and summarising what has been shared.

Communicating without judgement involves demonstrating genuine concern for the other person and talking about their experience.

Open-ended questions usually use “how” and “what” queries. You could say something like: “I’ve noticed some changes recently, what’s happening for you?” or “I see you are filling a prescription for sleep tablets. How are you sleeping?”

4. Refer the person to supports

People who are struggling with their mental health can benefit from sharing details with professionals, like general practitioners, or family and friends – but they might need encouragement to seek this support out.

The support system recommended should match the level of urgency. Urgent services include Lifeline for free 24-hour phone, chat, and text message^[30] support. The Suicide Call Back Service^[31] is also a free 24/7 counselling service.

If in doubt or in an emergency, dial 000.

Non-urgent and free online support is available from Head to Health^[32], the Black Dog Institute^[33] and Beyond Blue^[34].

Read more: How to look after your mental health if you're at home with COVID^[35]

Could training community pharmacists help?

Studies in Australia^[36], New Zealand^[37], Canada^[38] and abroad^[39] all point to pharmacists’ believing they need more training^[40] in mental health first aid.

Research^[41] suggests almost 70% of patients believe all pharmacists should have mental health first aid training. Patients report feeling significantly more comfortable speaking about mental illness with a pharmacist with this training.

And emerging evidence shows mental health first aid training can increase the quality^[42] of help provided by pharmacists.

In our study^[43], we found Australian pharmacists with mental health first aid training were more likely to intervene than untrained pharmacists.

While the overall quality of the first aid provided by both mental health first aid trained and untrained pharmacists was high, some key differences existed. Trained pharmacists assessed patients and encouraged other supports (such as from friends and family) more. They also felt more confident discussing suicide risk.

If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.

References

1. ^{^} three weeks (www.guild.org.au)
2. ^{^} pharmacists highly accessible (pubmed.ncbi.nlm.nih.gov)
3. ^{^} healthcare professionals (www.ncbi.nlm.nih.gov)
4. ^{^} first (mhaustralia.org)
5. ^{^} health concern (pubmed.ncbi.nlm.nih.gov)
6. ^{^} regular contact (pubmed.ncbi.nlm.nih.gov)
7. ^{^} provide mental health-related help (pubmed.ncbi.nlm.nih.gov)
8. ^{^} lack the confidence (pubmed.ncbi.nlm.nih.gov)
9. ^{^} respond to, raise or manage (pubmed.ncbi.nlm.nih.gov)
10. ^{^} 25% of the time (onlinelibrary.wiley.com)
11. ^{^} Pixels are not people: mental health apps are increasingly popular but human connection is still key (theconversation.com)
12. ^{^} increase by 25% (www.who.int)
13. ^{^} Australian population (www.abs.gov.au)
14. ^{^} 44% of Australians (www.abs.gov.au)
15. ^{^} recent survey (psychology.org.au)
16. ^{^} won’t seek help (www.blackdoginstitute.org.au)
17. ^{^} pharmacists in Australia (pubmed.ncbi.nlm.nih.gov)
18. ^{^} evidence-based treatments (pubmed.ncbi.nlm.nih.gov)
19. ^{^} lack of confidence (www.ncbi.nlm.nih.gov)
20. ^{^} prevents them (pubmed.ncbi.nlm.nih.gov)
21. ^{^} mental health crisis training (www.ncbi.nlm.nih.gov)
22. ^{^} Scared of needles? Claustrophobic? One longer session of exposure therapy could help as much as several short ones (theconversation.com)
23. ^{^} minimise stigma (pubmed.ncbi.nlm.nih.gov)
24. ^{^} increase knowledge (www.tandfonline.com)
25. ^{^} confidence (www.sciencedirect.com)
26. ^{^} intentions to help (pubmed.ncbi.nlm.nih.gov)
27. ^{^} Symptom guides (www.blackdoginstitute.org.au)
28. ^{^} Active listening (www.ncbi.nlm.nih.gov)
29. ^{^} Ways of doing this include (www.ucsfhealth.org)
30. ^{^} phone, chat, and text message (www.lifeline.org.au)
31. ^{^} Suicide Call Back Service (www.suicidecallbackservice.org.au)
32. ^{^} Head to Health (www.headtohealth.gov.au)
33. ^{^} Black Dog Institute (www.blackdoginstitute.org.au)
34. ^{^} Beyond Blue (www.beyondblue.org.au)
35. ^{^} How to look after your mental health if you're at home with COVID (theconversation.com)
36. ^{^} Australia (pubmed.ncbi.nlm.nih.gov)
37. ^{^} New Zealand (www.sciencedirect.com)
38. ^{^} Canada (www.ncbi.nlm.nih.gov)
39. ^{^} abroad (pubmed.ncbi.nlm.nih.gov)
40. ^{^} they need more training (pubmed.ncbi.nlm.nih.gov)
41. ^{^} Research (pubmed.ncbi.nlm.nih.gov)
42. ^{^} quality (ijmhs.biomedcentral.com)
43. ^{^} study (onlinelibrary.wiley.com)