Mental health concerns are a lurking crisis in America that have only been increased by the COVID-19 pandemic. According to the Centers for Disease Control and Prevention (CDC), 19% of adults in the United States struggled with a mental illness as of 2018. As of 2019, of the 19.2% of adults who received treatment for a mental illness 15.8% of them received a prescription. Compliance for psychiatric medications are known to be dismally low ranging around 50% of adherence for depression, 50-60% for schizophrenia, and 35% for bipolar affective disorder. The COVID pandemic has brought difficult times on many people: mental health concerns have escalated since the beginning of this unprecedented time. Since the COVID-19 pandemic, 40% of adults reported increased conditions associated with mental health issues. We are living in extraordinary times which have greatly impacted people’s mental well-being and this elevated mental health crisis since the COVID-19 pandemic has increased the number of prescriptions for mental illness.
A community pharmacists experience
As a community pharmacist, I see how pervasive mental health concerns are. Mental health does not only involve the patients who pick up prescriptions for SSRIs or antipsychotics, but it also has to do with the patients who have diabetes and the patients with osteoarthritis. Mental health issues do not only affect the psychiatric patient who picks up her risperidone and divalproex every month. It can also mean the patient with diabetes who gets too depressed from her life situation and doesn’t take her insulin or the patient with hypertension who struggles with anxiety, leading to difficulties taking his lisinopril regularly.
During this pandemic, many people have struggled with isolation and loneliness; some of these people turn to the pharmacist for an ear to hear their worries and sorrows. Community pharmacists are the most accessible healthcare provider available to serve the community. Many patients have opened up to me about their anxiety, their hopelessness, and their sadness. I have seen an uptick in prescriptions for anxiety since the pandemic. I know many other pharmacists have seen this burgeoning of prescriptions for anxiety medications. Personally, I have noticed more younger females receiving medications due to their struggle with anxiety than other groups but that may just be because of the population I serve. When counseling on a new prescription for anxiety, I talk to my patients about breathing exercises, walking outside to ease anxiety, and the importance of therapy in conjunction to medication such as Cognitive Behavioral Therapy (CBT). When I counsel on a new antidepressant, I ingrain the importance of taking the medication every day to ensure the medication is effective; I discuss self-care and the importance of therapy also. My goal is to convey a message that there is no stigma of mental illness when they talk to me.
I want to address the deeper issues of mental health during a counseling session and be able to have resources to refer patients. As a pharmacist, I am not able to do everything the patient needs but I want to be the first line of defense for hope and resources as the most accessible healthcare provider. People need connection, especially during this unprecedented time. Pharmacists have truly showed up fully to this national crisis, but we can do more to serve our patients.
The role of community pharmacists
Community Pharmacists ought to be trained to deal with mental health issues in all types of patients deeper than just counseling a patient on his/her/their medication or making pharmacotherapeutic recommendations. We may not be therapists, but we need to be able to know how to navigate the key issues of mental health conditions. I have the ability to talk to patients about some mental health concerns such as anxiety and depression from seeing friends and family struggle with these burdens, but I lack the training to make a deeper connection with these patients. Making connections with patients in a deep meaningful manner can enhance their lives significantly. David Woods Bartley gave a TEDx Talk about how connection saved his life. He opened up about how clinical depression had taken a hold of him and convinced him to commit suicide. He was on a bridge about to jump to his death when an EMT made a connection with him which gave him hope. Mr. Woods Bartley stresses how connection gives each one of us hope and how hope saves lives. How many times do you think a pharmacist has saved a life of a patient through connecting with that person? We cannot always tell who suffers from clinical depression; it could even be the happy nationally-recognized achiever such as David Woods Bartley. Martin Rubin, MD, a psychiatrist at Kaiser Permanente in Sacramento, California recently gave a talk about the mental health crisis in this country. He stated that pharmacists are in a unique position to connect with patients: pharmacists know what ailments the patients has due to their medication indications and pharmacists may be the only human interaction that a patient has in a day.
In creating deeper connections with patients, pharmacists should also have the knowledge of resources to refer patients. Pharmacists can refer patients to organizations such as National Alliance for Mental Illness (NAMI) which connects people who are working to overcome mental illness to support groups and social workers who can better address each individual’s needs. NAMI has a hotline to talk to a person; the organization developed a hotline specifically for COVID-related mental illness because they realized the pandemic has been difficult for many people. One branch of NAMI is partnering with its local police department to connect all the patients who are held under an involuntary psychiatric hospitalization have resources to cope with their illness when they are released. If NAMI could be a resource for pharmacists as it is to police departments, maybe we can alleviate some of the mental health crisis occurring in this country one person at a time.
Advocating for change
Despite pharmacists’ obvious role in providing mental health services, there are barriers that limit patient access to these services. The most obvious of these barriers include restrictive state scope of practice laws that limit patient access to services provided by the pharmacist and lack of an ability to directly bill for the services provided (provider status). The latter disincentives the businesses pharmacists work for to allow them the time they need to provide these mental health services. Advocating for expanded scope of practice for pharmacists and provider status can be effective ways to increase access to these mental health services.
In addition to increasing the prevalence of pharmacists in providing mental health services to our patients, it is imperative that mental health considerations for members of the profession be prioritized as well. Studies have shown that pharmacists experience a high degree of burnout, over 50% in health-systems and nearly 75% in community pharmacies! This high rate of burnout could contribute to higher rates of suicide and rates of substance use disorder within the profession. This is an unsustainable issue and needs to be addressed in order to ensure both pharmacist and patient safety. National pharmacy associations have taken up the cause of advocating for the mental health of pharmacists but more help is needed. In addition to advocating for policy changes to address the underlying system that contributes to these mental health effects, advocating within organizations can be effective to raise concerns about both employee and patient safety.
The pharmacist has a definite role in providing mental health services to our patients. By advocating for policy to expand these efforts, our patients can receive greater access to the care we provide while we fight for a system that appropriately cares for the practitioners wellbeing as well.
Guest writer profile
Amy Reese currently works as a community pharmacist at Wal-Mart Pharmacy in Southern California and a mass COVID vaccination clinic at Loma Linda University. She graduated from Loma Linda University School of Pharmacy in 2019. She completed a Masters degree in Bioethics through Loma Linda University School of Religion while she was in pharmacy school and graduated with her MBe in 2018. After pharmacy school, she went on to do a fellowship at Sherwin B. Nuland Summer Institute in Bioethics at Yale Interdisciplinary Center for Bioethics, Yale University. Dr. Reese started working in community pharmacy in 2019 and is passionate about the intersection of bioethics and pharmacy practice.