Community pharmacists can play a role in detecting warning signs for people experiencing a mental health problem. This can often be done through patient-centred conversations. For instance, if a sleeping pill for insomnia is requested, an open conversation could focus on physical symptoms but also discuss psychological wellbeing. For example, simply asking, ‘How are you feeling?’
When discussing mental health problems, ask questions you feel comfortable with and say them with confidence. This can be reassuring and shows you care. Avoid statements that imply judgement. You could say: ’I am concerned how often you have been buying non-prescription sleeping pills’, or ‘What’s troubling you with sleep?’.
These questions represent a natural part of a pharmacists interactions with patients and provide permission for a person to open up. Allow patients to process and answer. Don’t fill silent gaps.
Allow patients to ‘drive the conversation’, which could take some time. It is preferable to approach a patient who may need help when you have capacity. Unless the person is in crisis, the conversation can continue over multiple episodes of care.
Community pharmacists can support screening and risk assessment services as described in Pharmacists in 20231 Action 6 (health hubs) to build on their accessibility in primary care. The Sydney Pharmacy School research team has demonstrated pharmacists are capable of identifying adults at risk of depression, and referring appropriately, using the validated PHQ–9 screening tool.2 Pharmacists should consider how this and other tools can be integrated into normal work flows.
Tips for a targeted approach include:
- Tie-in screening with other services in your local area, as pharmacists play an important role in triage and referral.
- Establish your Primary Health Network pathways first to work collaboratively with other healthcare providers, such as GPs.
- Identify your target audience. Will it be for those needing advice for managing stress? Perhaps there is an opportunity to approach those who frequently request vitamin B12 or energy supplements.
- Set a realistic timeline. Will it be year-round, or only in a defined period (for example, mental health month)?
Pharmacy as a ‘safe space’
Pharmacies should be safe spaces for people to talk about their mental health problems and seek further information. Having signage, brochures, posters and making available resources including from beyond blue, all help to say that this pharmacy is ready to talk about your mental health. Ensuring all staff use non-stigmatising, ‘people-first’ language that does not disempower can help create a safe space, e.g, ‘a person experiencing schizophrenia’ rather than ‘the person is schizophrenic’.
As 1 in 5 Australians experience mental ill-health in any year, and 65% do not seek professional help,3 pharmacists can encourage help-seeking by dismantling the stigma barrier and creating a mental health-friendly space.
Finally, pharmacists need to be prepared for distressed patients and crisis situations which are inevitable in mental health services. Mental Health First Aid courses, including those offered by PSA, are recommended for all pharmacists.4
KEVIN OU BPharm, GradCertAppPharmPrac, MHFA, MPS is Training and Delivery Lead at PSA, a Mental Health First Aid Instructor and a Community Pharmacist.
LICHIN LIM BPharm (Hons), Cert IV TAE, MHFA, MPS is a Clinical Fellow at UTS, Manager – Knowledge Development at PSA and a practicing Community Pharmacist.
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- Pharmaceutical Society of Australia. At: psa.org.au/wp-content/uploads/2019/02/Pharmacists-In-2023-digital.pdf
- O’Reilly CL, Wong E, Chen TF. A feasibility study of community pharmacists performing depression screening services. Res Soc Adm Pharm 2015;11:364–381. At: https://www.ncbi.nlm.nih.gov/pubmed/25438728
- Australian Bureau of Statistics. National Survey of Mental Health and Wellbeing: 2007. At: https://bit.ly/2Rohg4f
- State-based web pages. For example: https://my.psa.org.au/s/training-plan/a110o000008r2A8/blended-mental-health-first-aid-nsw