Date: 11 July 2017
The growing recognition of mental health conditions in the community has heightened the focus on the role community pharmacies play in helping patients manage these issues.
Research shows mental health issues will affect one in every five Australians and are the third leading cause of disability burden in Australia, accounting for an estimated 27 per cent of the total years lost due to disability.
Approximately 14 per cent of Australians will be affected by an anxiety disorder in any 12-month period and about 3 per cent of Australians are affected by psychotic illness; such as schizophrenia.
While community pharmacies help manage patients experiencing mental illness across the broad spectrum, depression is the most common presentation, affecting about one in five women and one in eight men at some stage during their lives.
Depression is a lot more than just being in a low mood and according to beyondblue, a person may be depressed if, for more than two weeks, they have felt sad, down or miserable most of the time or have lost their interest or pleasure in some of their usual everyday activities – to name but a few symptoms.
Depression is a serious illness and one that affects a person’s physical and mental health. But, importantly, in the vast majority of cases it can be treated and the first step is seeking help from a health professional.
The National President of the Pharmacy Guild of Australia, George Tambassis, said pharmacists were among the health professionals who are able to help people experiencing depression.
“Many community pharmacies now provide services which can help people who are experiencing depression,” Mr Tambassis said.
“Some community pharmacists have even undertaken a special course in mental health first aid and as your most accessible health professionals they are a great place to begin when seeking advice or counselling for depression.”
This view is supported by Lifeline Research Foundation Executive Director Alan Woodward who also is a board director for Suicide Prevention Australia and a member of the Community Advisory Council for NSW Mental Health Commission.
Mr Woodward said pharmacists have a very important role in managing people’s health and wellbeing.
“They are a trusted point of contact and through this incidental contact they are well-placed to pick up something that someone has said which may indicate there is a problem,” he said.
“They can then try to find out more about the situation or be a point of reference to another healthcare professional.
“It’s one of those informal roles. Pharmacists may be seen as shopkeepers providing goods that you pay for but that is really selling the role of pharmacy way short.”
Dr Luke Martin, beyondblue’s Families Project Manager, said less than half of the people who have a mental health condition sought professional help.
“Pharmacists have a role to play. Clearly pharmacist have a relationship with their patients and they get to know them over time,” he said.
“In addition, a pharmacy is a non-stigmatising environment where a pharmacist and patient can have a very important conversation, particularly in the context of talking about your health.
“There may be more of an opportunity for such discussions in a pharmacy than in other places.
“Also, pharmacists who have a good relationship with their patients may notice over time a change in behavior in their patients.”
Mr Tambassis reinforced the importance of the easy accessibility of community pharmacies for mental health patients.
“Being able to walk in off the street and speak to a health professional who understands the issues and who can provide counselling is very important,” Mr Tambassis said.
“Pharmacists also are ideally placed to recognise potential early signs or symptoms of depression, anxiety or other mental health disorders in the community pharmacy setting.”
Mr Tambassis said that with more than 80 per cent of people using the same pharmacy regularly, their community pharmacist was able to more easily recognise changes in their behaviour or mood. Patients also felt more at ease talking to the pharmacists that they already knew and may have been dealing with for their health needs over a long period.
Mr Woodward said accidental counsellor was a term widely used to describe people who had informal contact with mental health patients – people like hairdressers and hospitality staff.
“But the role of the pharmacist has grown from accidental counsellor and they have a more defined role because of the mental health link to the medications,” he said.
“So it’s not the same as the role played by a person who just happens to be there. With the pharmacist the role is defined around health issues.”
Dr Luke Martin, agreed that the role of community pharmacist was pivotal to the wellbeing of people with mental health issues.
“We know that less than half of the people who have a mental health condition seek professional help,” he said.
“Clearly pharmacists have a relationship with their patients and they get to know them over time.
“In addition, a pharmacy is a non-stigmatising environment where a pharmacist and patient can have a very important conversation about their mental health. There may be more of an opportunity for such discussions in a pharmacy than in other places.”
Dr Martin said pharmacists who had a good relationship with their patients may notice over time a change in behavior in their patients – they may seem flatter, or lower in mood or lower in energy.
He said it was ideaI if the pharmacist noticed these signs and started a conversation with them about how they’re feeling.
Lifeline’s Mr Woodward said one of the things a pharmacist needed to be alert for concerned medications. There is value in checking that someone is familiar with the medications they are using and that they are alert to any problems which may arise as a result of using those medications.
“Medications taken for mental health issues can have some strong side effects, some of which are disclosed, some of which are not.”
Mr Tambassis said the role of community pharmacists in providing advice to people on medications to help manage depression was important.
“Some of these medicines take a while to have an impact and some also have side effects which the community pharmacist can explain and reassure the patient that such things are normal with some of these medicines,” Mr Tambassis said.
“Some people commencing on anti-depressants often experience a lot of side effects to start with and they could feel pretty terrible for a while. Having a pharmacist explain these side effects and alerting the patient as to what to expect is very important.
“Also important is having the pharmacist explain that these side effects are quite normal. They generally do not last long so the patient can expect to start feeling better after a short time as long as they continue taking their medicine as directed.”
Mr Woodward also pointed to the pharmacist’s role in medication management – ensuring dosages are taken, the timing of taking the medications and any other medication management issues.
There was great value, Mr Woodward said, in pharmacists being a “little bit more alert as to how the person is going with their medications and possibly have an ear out for comments which may indicate a problem.
“So if someone mentions the medications seem to be affecting their sleep then delve more deeply and find out what is going on. Ask a question or two.
“Also be alert for people buying large quantities of harmful medications. I know pharmacists have strong protocols in place but people can sometimes try to bypass these. Self-poisoning is one of the most frequently use methods of suicide in Australia and most likely those people are obtaining those medications through pharmacy.
“The second thing is to be alert to other things that may be going on in that person’s life. They may mention they are having financial problems or relationship problems, they may have lost their job.
“Off-hand remarks can often may provide clues to what is affecting the wellbeing of the person on the non-medical side of things. This is an area where Lifeline plays a huge role because we hear these things every day – things that may not be about mental health or suicide but just about struggling to cope.
“The third area in this incidental role is to have an eye out for who is around the person to give them support. Sometimes they may come in with a spouse or carer but often they may not so I think the pharmacist should be asking who is around to support this person.
“Social isolation is a very big issue and we did some research in which 60 per cent of respondents said they often felt lonely. That is showing a social undercurrent which might raise itself in various ways. For instance the person may hang around the counter a bit more and want to chat or they may just come out and say they have no-one to go home to.”
Dr Martin said it was important to try to have a private are in which to talk to the patient “Being aware of confidentiality is important. The patient may be from the local community and could be concerned about others overhearing the conversation given the stigma that exists. It is really important for the pharmacist to create a space where the patient can talk about the issues confidentially,” Dr Martin said.
Mr Woodward pharmacists needed to be trained in linking to other services in the community and knowing what was available locally for these patients.
“Lifeline is available nationally 24/7 but there will be other services available locally. It’s good if the pharmacist and their staff have a basic understanding of what is available and how to refer patients on.
“You have to tailor to the community’s needs and I am a great supporter of training for pharmacists and pharmacy staff where appropriate.
“Sometimes if a person is distressed, listening may be what is needed. But if the pharmacist becomes concerned about the patient’s welfare, or if the person indicates they may want to end their life then clearly there is a need for further action. This is where training in suicide prevention and crisis awareness would be important but such instances would be rare.
“They might benefit more from training in positive conversations along the lines of Are You OK. After asking the person this and exploring what they are saying the pharmacist would quickly get an idea of the magnitude of the problem.”
Dr Martin stressed the need for collaboration between health professionals.
Experience had shown that when someone was being treated by a team of health professionals the outcomes were often better.
“Having the GP and pharmacists on the same page is a basic need, particularly with a condition like depression where it can take a bit of trial and error to get the right mix between lifestyle changes, therapy and medication,” he said.
“It can take a little time to get the right mix so ongoing conversations between all the people involved with the patient results in better outcomes.”
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