The Role Of A Pharmacist In The Mental Healthcare And Well-Being Of His/Her Patients Beyond Accurately Dispensing Medicine
Physician prescribed medications are the usual treatment for mental illnesses and are (worldwide) often dispensed in the doctor’s office, but with the growth of mental disorders, pharmacists are ideally positioned to play a greater role in supporting people with a mental illness. This paper aims to describe the role in which a pharmacist can also participate in the mental healthcare and well-being of his/her patients beyond accurately dispensing medicine (not to imply this step isn’t crucial). Furthermore, this paper will consider the hardships and capabilities pharmacists have to become part (and possibly become the first part) of the broader mental healthcare team. More specifically, this paper focuses on an article in PharmacyToday. org released in September of 2018 detailing how pharmacists can now play a direct role in the process of recognizing and treating mental illness. The article’s relevant example regarded Mills Pharmacy which began offering depression screenings.
The article begins, “All it took was a sign, a simple 8 1⁄2" x 11" sheet of paper hung on the wall near the pharmacy counter of Mills Pharmacy in Hoover, AL, to give Robert Mills, PharmD, the chance to save a life. It said, ‘Interested in depression screening? Ask Robert for more details. ’” One patient, Ned Olson, opened up to pharmacist Robert Mills after he saw the sign, realized what had happened in his life, and the state he was in. While Dr. Mills noted the constant change in Olsen’s employment and Olsen constantly being out of medication, he had no idea the depth to which Olsen’s problems went. Furthermore, Dr. Mills was unaware as to how they were affecting his mental health. When Olsen told Dr. Mills there was much happening in his life such as family issues keeping him from seeing his children, etc. , Mills was shocked as he wouldn’t have known any of this had Olsen not responded to the depression screening sign and trusted Dr. Mills as they had formed a relationship through Dr. Mills’s pharmacy.
Upon learning Olsen’s circumstances, Dr. Mills administered the PHQ-2 inquiries about the frequency of depressed mood and anhedonia over the past two weeks. The PHQ-2 includes the first two items of the PHQ-9. The PHQ-2 is not intended diagnose or monitor depression; however, it is considered a “first step” approach to identifying the possibility of depression in a patient. If the questionnaire returns positive, the PHQ-9 is usually administered. This was the case regarding Mr. Olsen as Dr. Mills received a positive on the PHQ-2 questionnaire. With persistence, Dr. Mills continued to the PHQ-9 questionnaire. The PHQ-9 is not a long questionnaire either and again is not considered to be a diagnosis of any kind, simply a survey to see if one may need a mental health check-up. It is detailed in the corresponding PowerPoint presentation. Once administered, upon hearing Mr. Olsen thought about suicide every single day, Dr. Mills immediately began making appointments with Mr. Olsen’s doctors a few hours later, Olsen was on his way to an appointment that may very well have saved his life.
Dr. Mills’s pharmacy was a participant in the Depression Screenings in Pharmacy (DSIP) study, which demonstrated that reimbursing pharmacists for cognitive services creates a sustainable model for screenings and follow-up care for patients with depression. “As much as I talk about the financial aspects of this, as soon as I was told the [Olsen’s] story, principal investigator Jake Galdo, PharmD, MBA, BCPS, BCGP (now director for performance measurement at the Pharmacy Quality Alliance) called the Community Pharmacy Foundation [which funded the DSIP study] and said, ‘We saved a life. Because of this project, we’re seeing the difference Robert was able to make. ’” If left untreated, depression can become persistent and long-lasting. Mr. Olsen could have been subject to such mental health issues had he not been able to seek help with his pharmacist. If Mr. Olsen had even made the decision or thought to make an appointment with a primary care physician or psychiatrist, he may have had to wait quite a while until they were able to speak with him, diagnose him, and create appropriate appointments and medication regiments. Whereas an urgent call from a pharmacist, is often taken with more merit as it seems was the case regarding Mr. Olsen and Dr. Mills.
The current state of pharmacy is ever-changing as more responsibilities are bestowed upon pharmacists. Pharmacy today has resulted as an evolution over time, most of which has happened within the last decade. Obviously dispensing medications properly has been a main priority for hundreds of years. However, today, pharmacists are allowed to venture from the vaccination world to the mental health world. The progression of allowances to pharmacists seems to be highly beneficial to overall community health as it is so often pointed out that patients see their pharmacists most often, talk to them, and form a trusting relationship with them. Today’s circumstances allow pharmacists and all doctors to place the patient at the center of their care so they are always informed and make decisions pertaining to their wellbeing. Mr. Olsen’s decision to go in for depression screening is an excellent example of this as he was given an option and made a choice to better his mental state starting with his pharmacist, Dr. Mills’s help.
While mental health screening availability at your local psychiatrist is extremely convenient, familiar, and potentially lifesaving, it does have its hurdles. Work pertaining to mental health requires time and excellent education on the topic, that is, likely more education than one may receive in a PharmD program. Pharmacists need to be dedicated to put in the time and the work to learn about conditions, questionnaires (reading the results), having a plan in play to deal with issues of depression (recommended by the USPSTF), and of course the treatments and which interact with which as there are many intricacies when dealing with said medications. It is good practice to notify the mentioned mental health experts in your area that you will begin screenings for depression as one wouldn’t want members of your healthcare team to be confused as to why you, the pharmacist, were calling as opposed to the patient.
Pharmacists must, as with everything, leave all stigmas “at the door. ” Assessing mental health was described in the article to be as simple as assessing blood pressure. There are levels that are within the “norm, ” and those which are not and need to be addressed. However, in this country, there are still stigmas formed around mental health issues and pharmacists need to be comfortable enough with the topic to make their patients feel comfortable speaking with them about their current condition. This includes being knowledgeable about all of the aforementioned areas concerning mental health and using sensitivity and recognition of the fact that there is a stigma. Extra measures may need to be taken to properly speak with a patient about their mental wellbeing such as a private room. The most important task a pharmacist must complete regarding any illness is to make the patient feel comfortable speaking with them about it, this applies to mental health as it does every other health topic.
The article and references from the USPSTF discuss good times to have screenings. Such patients include pregnant and postpartum women, and those with a chronic disease such as diabetes, COPD, cardiac diseases, or those who are post-MI. In the article it was suggested to screen for depression at convenient times, such as National Diabetes Month (simply offer a free screening to each patient with diabetes) and similarly with American Heart Month. While pharmacists do many jobs, it is only a five minute survey and as the article said, you can always make or find five minutes. Dr. Ballou, a contributor to the article, made a very important point to follow-up with patients. Pharmacists often know better than anyone how chemicals are going to react and have seen adverse reactions in other patients, etc. Furthermore, pharmacists are educated on the dosages and timetables pertaining to prescribed medications. If someone you referred to a mental healthcare specialist returns to your pharmacy to pick-up their medications, take the time to go through how their medications will work, how long it will take them to work, what some adverse side effects may be, encourage patience since quite often such medications take time to work, and finally be available and open to any questions, always making the patient feel comfortable. Also, as part of your educational portion of beginning depression screenings be aware of treatments which may work that are not medications and consult with members of your local healthcare team to try to find solutions for your patients.
