Almost everywhere in the world, pharmacists are the most accessible health care provider. Most people find it easier to step into their local pharmacy to ask about medication side effects than to try and make an appointment with a doctor. Pharmacists are also the final checkpoint between patients and prescription drugs: they make sure that the right drugs and right doses are prescribed; that prescribed drugs aren’t interacting in harmful ways; and that patients understand the hows, whys, and whens.

Yet, likely because of stigma, the reality is most patients don’t talk to their pharmacists, especially when it comes to their mental health issues and medications. As such, most pharmacists don’t work within their full scope of practice in mental health,(1) and patients’ support and information needs from their pharmacists remain unmet.

How can pharmacists help patients with mental health issues?

Pharmacists can be an important member of a patient’s care team when it comes to supporting their mental health.

1. Monitor and improve medication adherence

Adherence is a larger problem among patients on psychotropic medications compared to other chronic medications. Non-adherence rates to psychotropic medications, such as those used for treating depression, schizophrenia or bipolar disorder, are as high as 60%.(2) Poor adherence to psychotropic medications increases the risk of relapse, worsens symptoms and prognosis, reduces an individual’s quality of life, and poses significant economic costs to both the individual and the society.(3) Studies have shown that pharmacists can effectively improve adherence rates to psychotropic medications by providing medication counselling and treatment monitoring.(4)

2. Manage side effects and review medications

Medical co-morbidity is very common among mental health patients. Not only are patients often prescribed multiple psychotropic medications to manage comorbid mental health disorders, but also medications for other non-psychiatric conditions. This increases the risk of drug-drug interactions and medication misadventures (i.e. adverse events, side effects and medication errors). By carefully reviewing medications, and helping manage side effects, pharmacists can improve treatment outcomes and reduce medication misadventures.

3. Mental health screening

Mental illnesses can affect just about anybody, and early detection along with effective treatment can greatly improve symptoms, and increase recovery and remission rates. Moreover, there are many commonly prescribed non-psychiatric drugs that include psychiatric side effects, such as depression and anxiety. These include beta-blockers, statins, stimulants and anticonvulsants, among other drug classes. Given the high volume of patients seen regularly by pharmacists, they are well-placed to identify signs and symptoms of mental health problems early-on. Pharmacists can review medications that carry a risk of exacerbating mental health issues, watch out for signs of mental illnesses, routinely offer mental health screening, and provide treatment counselling to patients.(5)

4. Rapid triage and referrals

An extremely important, but often overlooked, role pharmacist plays is performing triage and providing timely referrals to health and social support services. Patients with mental illnesses often need more than medications in order to recover. In addition to medications, most patients will also require psychosocial support and counselling, and access to social services and financial support. Pharmacists are well-positioned to triage patient needs and coordinate patients’ other care needs, making referrals as appropriate.

What’s hindering pharmacists’ role in mental health?

Research studies with pharmacists have identified several key barriers to providing mental health care to patients.

1. Time and competing priorities

Pharmacists are not usually remunerated for time spent providing (additional) counselling, for listening to patients’ health and mental health problems, or for performing mental health screenings.(6) These are all necessary steps to help address any adherence issues, or providing proper triaging and referrals. Pharmacists also have other priorities that need their time and attention, such as preparing and filling prescription orders.

2. Trust and rapport

It takes time to build trust and rapport with patients, and these are necessary ingredients for being able to have fruitful conversations about mental health problems—particularly given the stigma around mental health.(1) Yet many pharmacists struggle to find time to be good listeners or conversationalists, which is needed for building trust.

3. Privacy and stigma

Despite increasing awareness of mental health issues, there is a lot of stigma around mental health, and it isn’t something that is openly talked about in most societies. Patients and pharmacists need to be able to discuss mental health issues in a private space. Unfortunately, most pharmacists do not have access to private space; nearly all conversations happen quite openly, and can be easily overheard by other people waiting in line.(5)

4. Confidence and training

Many pharmacists report low confidence and lack of training in providing mental health support, particularly during mental health crises.(1) Thus, there has been an increased interest in providing mental health first aid training, and general mental health education, as part of pharmacist education and training programs. Training in mental health among pharmacists has shown to reduce mental health stigma, and build confidence and skills in providing appropriate services to mental health patients.(7)

How can Carebook help?

With a patient-centered, pharmacist-friendly approach, Carebook is evolving its digital solution to support pharmacists in providing effective and appropriate care to all patients. It targets the most common barriers to providing treatment and support, including the lack of opportunity to build trust and rapport, the lack of tools to perform mental health screenings, and the lack of training and confidence. Our solution is informed by the most up-to-date evidence that prioritizes the needs of patients and pharmacists, and, most importantly, considers the wide-reaching benefits of human engagement. If you’re a pharmacy, pharmacy franchise, or are interested in looking at our enterprise solutions, get in touch with us.

 

References

1. Rubio-Valera M, Chen TF, O’Reilly CL. New roles for pharmacists in community mental health care: a narrative review. Int J Environ Res Public Health. 2014;11(10):10967–10990. doi: 10.3390/ijerph111010967.
2. García S, Martínez-Cengotitabengoa M, López-Zurbano S, Zorrilla I, López P, Vieta E, González-Pinto A. Adherence to Antipsychotic Medication in Bipolar Disorder and Schizophrenic Patients: A Systematic Review. J Clin Psychopharmacol. 2016 Aug;36(4):355-71.
3. Ho SC, Chong HY, Chaiyakunapruk N, Tangiisuran B, Jacob SA. Clinical and economic impact of non-adherence to antidepressants in major depressive disorder: A systematic review. J Affect Dis. 2016; 193: 1-10.
4. Bell S, McLachlan AJ, Aslani P, Whitehead P, Chen TF. Community pharmacy services to optimise the use of medications for mental illness: a systematic review. ANZ Health Policy 2005, 2:29.
5. O’Reilly CL, Wong E, Chen TF. A feasibility study of community pharmacists performing depression screening services. Res Social Adm Pharm. 2015;11(3):364-81.
6. Murphy AL, Phelan H, Haslam S, Martin-Misener R, Kutcher SP, Gardner DM. Community pharmacists’ experiences in mental illness and addictions care: a qualitative study. Subst Abuse Treat Prev Policy, 2016; 11: 6.
7. O’Reilly CL, Bell JS, Kelly PJ, Chen TF. Impact of mental health first aid training on pharmacy students’ knowledge, attitudes and self-reported behaviour: a controlled trial. Aus New Zeal J Psych, 2011; 45(7): 549-557,