Community pharmacists are ideally placed to provide healthcare screening and advice to people with mental health problems. Through risk factor screening, healthy living advice and supporting safe and effective use of psychiatric medication, they can contribute to improved health outcomes. To do so community pharmacists will need to have a good understanding of mental health conditions and related evidence-based interventions.
This article considers how we can enhance the role of community pharmacists in improving health outcomes for people with mental health problems. We will refer to findings from global studies, including two studies we carried out on community pharmacists’ mental health literacy and attitudes towards mental illness in the United Kingdom. The mental health literacy measure we designed for this study was later adopted in a study by researchers at the University of Nigeria, to compare the MHL of pharmacists in Nigeria with that of pharmacists in developed countries (2020).
Community pharmacists are accessible without appointment on the high street for everyone, including for persons with mental health problems. We know from research studies that community pharmacists are often consulted about psychiatric medications. This puts them in an ideal situation to not only provide advice on how to take psychiatric medications and which side-effects to expect, but also to detect signs of mental illness and provide wider health advice and refer people to other services.
We know that medication counselling and monitoring by community pharmacists can improve adherence, and safe and effective use of psychiatric medication. This can also prevent relapses that require hospital admission. Pharmacists in our study, however, believed that people with mental health problems did not receive adequate medicine information from their general practitioner or psychiatrist.
People with severe mental illness have a lower life expectancy as they have an increased risk of having other diseases, often associated with risk factors such as smoking, poor diet and lack of exercise. They might also suffer from adverse effects of psychiatric medication. They are also less likely to access physical health care than other patients. Screening for risk factors and healthy living advice by community pharmacists can improve their health outcomes.
In our research we looked at the various factors that affect the degree to which pharmacy services are provided to people with mental health problems.
Mental health literacy (MHL) refers to the knowledge required to recognize, manage and prevent mental disorders. A lack of MHL makes it difficult to provide effective pharmacy care. There are only few studies about MHL among community pharmacists. Our survey of community pharmacists in 2017 was the first such study in Britain.
Pharmacists in our study were able to recognise symptoms of depression, but less so for bipolar disorder and schizophrenia. A high proportion of pharmacists wrongly believed having a split personality was a symptom of both these conditions, resembling the misconceptions among the general public in England.
Pharmacists’ attitudes are important for the delivery of pharmaceutical care to people with mental conditions. For example, in Australia a significant association was found between social distance and pharmacists’ willingness to provide services to schizophrenia patients, while in Canada community pharmacists expressed discomfort with providing pharmaceutical care to patients with mental illness.
In our studies British community pharmacists provided significantly fewer pharmacy services to patients with mental illness than to cardiovascular patients. This was related to attitudes towards mental illness. They were less comfortable providing services to patients with mental health problems. Mental health stigma – expressed as desired social distance and perceived likelihood of violence – was higher for schizophrenia and bipolar disorder than for depression, with many pharmacists having misconceptions about these two conditions.
Less than one third of practicing community pharmacists in our study felt they had sufficient training in mental health conditions and psychiatric medications. We, and other authors before us, think that it is necessary to improve undergraduate and continuing mental health education for pharmacy students and practicing community pharmacists to improve their attitudes, knowledge and confidence in mental health.
People with mental illness will likely receive more pharmacy services if misconceptions, stigma and negative attitudes are reduced. To address the disparities in access to physical health care, the physical health needs of people with mental health problems also need to be covered in pharmacists’ training.