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Jerry McKee Pharm.D, MS, BCPP
Medical Affairs Director of Pharmacy
Community Care of North Carolina
Raleigh, NC

Carol A. Ott, PharmD, BCPP
Clinical Professor of Pharmacy Practice
Clinical Pharmacy Specialist, Psychiatry
Eskenazi Health/Midtown Community Mental Health
Purdue University College of Pharmacy
Indianapolis, IN

Mental illness is common throughout the United States, affecting 43.8 million people (18.5% of the US population) each year1. Overall, only about half of people affected receive treatment2. For patients with mental illness, there are many barriers to accessing optimal care, including lack of access to treatment and accurate disease state information, limited financial resources, inadequate transportation, and stigma. People with mental illness are treated differently, even by healthcare professionals. People suffering from mental illnesses perceive stigma related to their disorders and feel discomfort caused by healthcare providers and the general public. It is essential that everyone, including healthcare students and professionals, prevent personal stigma from inflicting negative patient experiences and correct preconceived notions to align with research findings.

Mental Health First Aid (MHFA) is one potential training tool which can begin a process of bending the curve toward minimizing stigma associated with mental illness. MHFA is an 8-hour course that gives people the skills to help someone who is developing a mental health problem or experiencing a mental health crisis3. The evidence behind the program demonstrates that it does build mental health literacy, helping the public identify, understand, and respond to signs of mental illness5,6,7. MHFA efforts are coordinated by the National Council for Behavioral Health, the Maryland Department of Health and Mental Hygiene, and the Missouri Department of Mental Health to ensure the quality and standardization of the program nationwide, certify instructors to teach MHFA in local communities, and support program growth. Many schools of pharmacy are integrating MHFA training into their curriculum, or making it available to students at little or no cost. CPNP Foundation will be offering MHFA at CPNP 2018 for students in attendance.

The College of Psychiatric and Neurologic Pharmacists (CPNP) student chapters may consider raising their colleagues’ awareness of MHFA training and its importance as a goal. CPNP Purdue student chapter members reported a study about the impact of MHFA training on ratings of social distance using the Social Distance Scale and the Attitudes to Mental Illness Scale. The study participants included pharmacy and non-pharmacy students. All students showed an increase in awareness and acceptance of people with schizophrenia and depression in social and living situations on several indicators, with pharmacy students demonstrating greater improvements. Students responded well to recruiting efforts for this study, indicating the possibility that incorporating this training into the professional curriculum would be well-received.8

The CPNP Foundation, in collaboration with National Alliance on Mental Illness (NAMI), conducted an online survey of individuals with mental health conditions, or family members, about their interactions with their community pharmacists. Eighty percent of all respondents reported that they exclusively used a community pharmacy to fill their prescriptions for mental health medications. Responses demonstrate several opportunities in the areas of access to pharmacists, privacy, and professional relationship-building. They also increased assistance with effectiveness or safety monitoring of mental health medication3. It is clear from the survey that many respondents and their families value the relationship with their pharmacist. Due to accessibility and trust, community pharmacists have a tremendous opportunity to positively impact individuals living with mental illness, their families, and the patient’s healthcare providers. This further enhances evidence-based treatments leading to improved outcomes and patient satisfaction. In a survey of North Carolina community pharmacists designed to assess perceptions towards working with persons with severe and persistent mental illness (SPMI), researchers determined that key barriers identified in preventing community pharmacists from providing optimal care and services to this population are lack of time and lack of confidence in managing and monitoring medications used to treat SPMI.4

MHFA training is intended for all people, but may be of particular benefit to those regularly interacting with persons affected by mental illness, such as community pharmacy employees. As the CPNP Foundation survey points out, persons with mental illness typically receive their medications from community pharmacies and value the relationship with their pharmacist. Beginning with the register clerk, pharmacy technicians, pharmacists, pharmacy student trainees, and store managers, all community pharmacy personnel could benefit from this training.  MHFA builds health literacy, helps participants better understand presenting signs and symptoms and addresses the appropriate response to an exacerbation of mental illness.  

While MHFA training is known to be effective for the general public in reducing stigma and improving confidence in interventions with people affected by mental health disorders, research highlights the growing recognition of additional training in actual personal interactions and improvement in confidence that is needed in healthcare professional educational programs. Pharmacy students in particular may benefit from MHFA training early in their education. Improving the comfort and confidence of trainees in working with persons with mental illness is another step in decreasing stigma. It is clear MHFA training can be an important addition to educational programs aimed at optimizing patient care and outcomes as well as increasing the job satisfaction of the community pharmacy health care professional.

References

  1. National Alliance on Mental Illness. https://www.nami.org/Learn-More/Mental-Health-By-the-Numbers . Accessed August 28, 2017.
  2. National Institute of Mental Health.  http://www.nimh.nih.gov/health/statistics/prevalence/any-mental-illness-ami-among-adults.shtml . Accessed September 20, 2015.
  3. Characterizing the Relationship between Individuals with Mental Health Conditions and Community Pharmacists-Results from a 2012 Survey. College of Psychiatric and Neurologic Pharmacists Foundation. https://cpnp.org/_docs/foundation/2012/nami-survey-report.pdf  
  4. Watkins A, McKee J, Hughes C, Pfeiffenberger T. Community pharmacists’ attitudes toward providing care and services to patients with severe and persistent mental illness. J Am Pharm Assoc (2003). 2017;57(3):S217- S224.e2. DOI: 10.1016/j.japh.2017.02.020. PubMed PMID: 28408170.
  5. Program History.  Mental Health First Aid Canada. Available at www.mentalhealthfirstaid.ca/EN/about/Pages/ProgramHistory.aspx .  Accessed September 20, 2015.
  6. O’Reilly CL, Bell JS, Kelly PJ, Chen TF.  Impact of mental health first aid training on pharmacy students’ knowledge, attitudes and self-reported behavior:  a controlled trial.  Aust N Z J Psychiatry 2011;45:549-557.
  7. Bond KS, Jorm AF, Kitchener BA, Reavley NJ. Mental health first aid training for Australian medical and nursing students: an evaluation study. Bmc Psychol. 3rd ed. 2015;3(1). DOI: 10.1186/s40359-015-0069-0. PubMed PMID: 25914827; PubMed Central PMCID: PMC4399395.
  8. McCormack Z, Gilbert JL, Ott C, Plake K. Mental Health First Aid training among pharmacy and other university students and its impact on stigma toward mental illness.  Presented at the College of Psychiatric and Neurologic Pharmacists Annual Meeting.  Phoenix, AZ. April 2017.
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