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Rajkumar J. Sevak, PhD, RPh

Mental illness affects approximately one in five adults (18.9% or 46.6 million people) annually in the United States.1 Negativity and stigma towards psychiatric illnesses are prevalent in the general population. Stigma could be conceptualized as a sum of problems of knowledge (ignorance), attitudes (prejudice), and behavior (discrimination).2 The prevalent culture is often portrayed in the press and media (e.g., movies, shows), which routinely depict individuals with mental illness in the negative light. The stereotyping of people with mental disorders in the media as unpredictable, dangerous, aggressive, and untrustworthy leaves their detrimental image in the society.3,4 The negative societal views for mental illness lead to prejudice and discrimination against people living with mental illness from all walks of life, such as employment, housing, and social relationships. 

A less recognized fact is that stigmatized attitudes towards psychiatric patients also exist among healthcare professionals and students.5,6 The healthcare providers and students are part of society, and their attitudes may reflect prevailing cultural norms and perceptions from society at large. However, it is troubling when stigmatized attitudes come from healthcare providers, to whom people look up to for help with physical and mental illness. In particular, stigmatization of mental illness by pharmacists may lead to impaired communication with patients, resulting in unmet healthcare needs of patients. For example, a stigmatizing pharmacist likely wouldn’t inform a woman who purchases St John’s wort from a pharmacy aisle, for her depressive symptoms, that the supplement could interact with her oral contraceptives. The same pharmacist may appear less approachable to another patient who is frustrated by jitteriness caused by sertraline that she started two weeks ago for her anxiety disorder. Indeed, several articles have reported impaired communication of stigmatizing pharmacists with patients. For example, Rickles et al. (2010) reported that pharmacists were less willing to provide services to patients with mental illness than to patients with asthma.7 Phokeo et al. (2004) evaluated attitudes and interactions of community pharmacists with psychiatric patients and reported that a significantly higher proportion of pharmacists expressed discomfort discussing symptoms and medications with patients with a mental illness (36%) than with patients with a physical illness (6%).8 Negative attitudes and mental health stigma among pharmacy students are also reported in a series of international surveys9. A number of studies thus highlight stigmatizing attitudes of practicing pharmacists and pharmacy students toward psychiatric patients. 

The fear of stigmatization by health professionals, including pharmacists, may limit individuals from seeking clinical help for their mental health conditions.10,11 Not only does stigma add to the disease burden by preventing people from seeking timely help, but delays in and avoidance of treatment substantially add to healthcare costs. The US Surgeon General and World Health Organization have long cited stigma as a key barrier to successful treatment engagement, including seeking and sustaining participation in health services.12,13 Pharmacists’ stigma towards mental illness can therefore deteriorate the provider-patient relationship, deter patient engagement, and result in inferior treatment outcomes.14 Thus, there is a clear need for effective methods to improve stigmatizing attitudes of pharmacists and students toward mental illness, as disrupting this stigma could improve patient care.

A variety of strategies have been evaluated for their ability to improve stigmatizing attitudes of pharmacists and students. These strategies include furthering education and awareness, promoting contact with people with mental disorders, and accurate representations of psychiatric patients.15 The use of non-judgmental language in healthcare settings could play an important role in reducing stigma. For example, identifying “a patient with substance-use-disorders” as opposed to an “addict” and calling “a drug screen positive for substance use” instead of “a dirty drug screen” could go a long way in creating a judgement-free healthcare environment. Also, pharmacy students’ didactic experiences that incorporate empathy and patient interactions could improve students’ perspectives for mental health. For example, O’Reilly et al. (2010) showed that the involvement of a consumer-educator in pedagogy decreased pharmacy students’ negative attitudes towards mental illness. 16 A consumer educator is a person who has previously received psychiatric care and voluntarily works to educate professionals, students, and society on mental illness. Further, Patten et al. (2012) demonstrated a significant reduction in stigma among pharmacy students with contact-based education, where students interacted socially with patients having a mental illness.17 Additionally, several mental health organizations promote mental health stigma reduction by facilitating judgement-free cultures at work-places, healthcare settings, and the community.

In sum, understanding the attitudes of pharmacists and pharmacy students toward people with mental disorders is important because pharmacists are among the most frequently consulted healthcare providers in communities. Awareness and adoption of evidence-based approaches in healthcare settings, workplaces, and educational curriculums could help attenuate mental health stigma among pharmacists and students.

References

  1. Substance Abuse and Mental Health Services Administration. (2018). Key substance use and mental health indicators in the United States: Results from the 2017 National Survey on Drug Use and Health (HHS Publication No. SMA 18-5068, NSDUH Series H-53). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www. samhsa.gov/data
  2. Thornicroft, G, Rose D, Kassam A, et al. Stigma: ignorance, prejudice, or discrimination? The British Journal of Psychiatry. 2007;190:192-193.
  3. Angermeyer MC, Beck M, and Matschinger H. Determinance of the public’s preference for social distance from people with schizophrenia. Canadian Journal of Psychiatry. 2003;48(10):663-668.
  4. Corrigan PW and Watson AC. Understanding the impact of stigma on people with mental illness. World Psychiatry. 2002;1(1):16-20.
  5. Sartorius N. Iatrogenic stigma of mental illness. British Medical Journal. 2002;324(7352):1470-1471.
  6. Kassam A, Glozier N, Leese M, et al. A controlled tiral of mental illness related stigma training for medical students. BMC Medical Education. 2011;11:51-51.
  7. Rickles NM, Dube GL, McCarter A, et al. Relationship between attitudes toward mental illness and provision of pharmacy services. Journal of the American Pharmacists Association. 2010;50(6):704-713.
  8. Phokeo V, Sproule B, Raman-Wilms L. Community pharmacists’ attitudes toward and professional interactions with users of psychiatric medication. Psychiatric Services. 2004;55(12):1434-1436.
  9. Bell JS, Aaltonen SE, Airaksinen MS, et al. Determinants of mental health stigma among pharmacy students in Australia, Belgium, Estonia, Finland, India, and Latvia. The International Journal of Social Psychiatry. 2010;56(1):3-14.
  10. Barney LJ, Griffiths KM, Jorm AF, at al. Stigma about depression and its impact on help-seeking intentions. Australian and New Zealand Journal of Psychiatry. 2006;40(1):51-54.
  11. Scocco P, Preti A, Totaro S, et al. Stigma, grief, and depressive symptoms in help-seeking people bereaved through suicide. Journal of Affective Disorders. 2019;244:223-230.
  12. U.S. Surgeon General. Rockville, Maryland: Center of Mental Health Services, National Institute of Mental Health; 1999. Mental health: A report of the U.S. Surgeon General.
  13. World Health Report (2001) Mental health: new understanding, new hope. World Health Organization: Geneva, Switzerland.
  14. Corrigan PW, Mittal D, Reaves CM, et al. Mental health stigma and primary health care decisions. Psychiatry Research. 2014;218(1-2):35-38.
  15. Corrigan PW, Green A, Lundin R, et al. Familiarity with and social distance from people who have serious mental illness. Psychiatric Services. 2001;52(7):953-958.
  16. O'Reilly, C. L., Bell, J. S., & Chen, T. F. Consumer-led mental health education for pharmacy students. American Journal of Pharmaceutical Education. 2010;74(9):167.
  17. Patten SB, Remillard A, Phillips L, et al. Effectiveness of contact-based education for reducing mental illness-related stigma in pharmacy students. BMC Medical Education. 2012;12:120.
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