Pharmacists’ roles in mental healthcare: Past, present and future
Mental illnesses cause significant disease burden globally, with medicines being a major modality of treatment for most mental illnesses. Pharmacists are accessible and trusted healthcare professionals who have an important role in supporting people living with mental illness. This commentary discusses the role of pharmacists in mental healthcare, as part of multidisciplinary teams, the current evidence to support these roles, and the training, remuneration and policy changes needed to recognize these roles and embed pharmacists as core members of the mental healthcare team.
Finley PR, Crismon ML, Rush AJ. Evaluating the impact of pharmacists in mental health: a systematic review. Pharmacotherapy. 2003;23(12):1634-1644. https://doi.org/10.1592/phco.23.15.1634.31952
International Pharmaceutical Federation (FIP). Focus on mental health: the contribution of the pharmacist. https://www.fip.org/files/Focus_on_mental_health_-final.pdf (accessed accessed Sep 4, 2021).
Royal Pharmaceutical Society. No health without mental health: How can pharmacy support people with mental health problems? London: RPS; 2018.
Pharmaceutical Society of Australia. Mental health care project. A framework for pharmacists as partners in mental health care. https://my.psa.org.au/servlet/fileField?entityId=ka17F0000000y1WQAQ&field=PDF_File_Member_Content__Body__s (accessed accessed Sep 4, 2021).
Miller WA, Corcella J. Professional pharmacy functions in community mental health centers. J Am Pharm Assoc. 1972;12(2):68-73.
Ivey MF. The pharmacist in the care of ambulatory mental health patients. Am J Hosp Pharm. 1973;30(7):599-602.
Williams T, Purvis TL. Development of an outpatient pharmacist-managed clozapine clinic. Am J Health Syst Pharm. 2012;69(14):1192-1195. https://doi.org/10.2146/ajhp110461
Lin C, Strauss R, Hong J, et al. Impact of a pharmacist-administered long-acting injectable antipsychotic service in a supermarket-based community pharmacy on medication adherence. J Am Coll Clin Pharm. 2019;2(4):343-348. https://doi.org/10.1002/jac5.1159
Caley CF, Webber D, Kurland M, Holmes P. The role of a psychiatric pharmacist in college health. J Am Coll Health. 2010;58(4):393-396. https://doi.org/10.1080/07448480903380334
Gibu M, Clark J, Gold J. Mental health pharmacists as interim prescribers. Ment Health Clin. 2018;7(3):111-115. https://doi.org/10.9740/mhc.2017.05.111
Mohammed MA, Moles RJ, Chen TF. Impact of Pharmaceutical Care Interventions on Health-Related Quality-of-Life Outcomes: A Systematic Review and Meta-analysis. Ann Pharmacother. 2016;50(10):862-881. https://doi.org/10.1177/1060028016656016
Chen TF. Pharmacist-Led Home Medicines Review and Residential Medication Management Review: The Australian Model. Drugs Aging. 2016;33(3):199-204. https://doi.org/10.1007/s40266-016-0357-2
Bell JS, Aslani P, McLachlan AJ, Whitehead P, Chen TF. Mental health case conferences in primary care: content and treatment decision making. Res Social Adm Pharm. 2007;3(1):86-103. https://doi.org/10.1016/j.sapharm.2006.05.005
Gisev N, Bell JS, O'Reilly CL, Rosen A, Chen TF. An expert panel assessment of comprehensive medication reviews for clients of community mental health teams. Soc Psychiatry Psychiatr Epidemiol. 2010;45(11):1071-1079. https://doi.org/10.1007/s00127-009-0148-8
Chong WW, Aslani P, Chen TF. Multiple perspectives on shared decision-making and interprofessional collaboration in mental healthcare. J Interprof Care. 2013;27(3):223-230. https://doi.org/10.3109/13561820.2013.767225
Chong WW, Aslani P, Chen TF. Shared decision-making and interprofessional collaboration in mental healthcare: a qualitative study exploring perceptions of barriers and facilitators. J Interprof Care. 2013;27(5):373-379. https://doi.org/10.3109/13561820.2013.785503
Chong WW, Aslani P, Chen TF. Pharmacist-patient communication on use of antidepressants: a simulated patient study in community pharmacy. Res Social Adm Pharm. 2014;10(2):419-437. https://doi.org/10.1016/j.sapharm.2013.05.006
Richardson TE, O'Reilly CL, Chen TF. A comprehensive review of the impact of clinical pharmacy services on patient outcomes in mental health. Int J Clin Pharm. 2014;36(2):222-232. https://doi.org/10.1007/s11096-013-9900-y
Rubio-Valera M, Serrano-Blanco A, Magdalena-Belío J, et al. Effectiveness of pharmacist care in the improvement of adherence to antidepressants: a systematic review and meta-analysis. Ann Pharmacother. 2011;45(1):39-48. https://doi.org/10.1345/aph.1p429
Al-Jumah KA, Qureshi NA. Impact of pharmacist interventions on patients' adherence to antidepressants and patient-reported outcomes: a systematic review. Patient Prefer Adherence. 2012;6:87-100. https://doi.org/10.2147/ppa.s27436
Elkhodr S, Saba M, O'Reilly C, Saini B. The role of community pharmacists in the identification and ongoing management of women at risk for perinatal depression: A qualitative study. Int J Soc Psychiatry. 2018;64(1):37-48. https://doi.org/10.1177/0020764017746198
El-Den S, O'Reilly CL, Chen TF. Development and Psychometric Evaluation of a Questionnaire to Measure Attitudes Toward Perinatal Depression and Acceptability of Screening: The PND Attitudes and Screening Acceptability Questionnaire (PASAQ). Eval Health Prof. 2019;42(4):498-522. https://doi.org/10.1177/0163278718801434
El-Den S, O'Reilly CL, Gardner DM, Murphy AL, Chen TF. Content validation of a questionnaire measuring basic perinatal depression knowledge. Women Health. 2019;59(6):615-630. https://doi.org/10.1080/03630242.2018.1539431
O'Reilly CL, Wong E, Chen TF. A feasibility study of community pharmacists performing depression screening services. Res Social Adm Pharm. 2015;11(3):364-381. https://doi.org/10.1016/j.sapharm.2014.08.013
Miller P, Newby D, Walkom E, Schneider J, Li SC. Depression screening in adults by pharmacists in the community: a systematic review. Int J Pharm Pract. 2020;28(5):428-440. https://doi.org/10.1111/ijpp.12661
El-Den S, McMillan SS, Wheeler AJ, Ng R, Roennfeldt H, O'Reilly CL. Pharmacists' roles in supporting people living with severe and persistent mental illness: a systematic review protocol. BMJ Open. 2020;10(7):e038270. https://doi.org/10.1136/bmjopen-2020-038270
Sud D, Laughton E, McAskill R, Bradley E, Maidment I. The role of pharmacy in the management of cardiometabolic risk, metabolic syndrome and related diseases in severe mental illness: a mixed-methods systematic literature review. Syst Rev. 2021;10(1):92. https://doi.org/10.1186/s13643-021-01586-9
Murphy AL, Gardner DM, Jacobs LM. The patient experience in a community pharmacy mental illness and addictions program. Can Pharm J (Ott). 2019;152(3):186-192. https://doi.org/10.1177/1715163519839424
Murphy AL, Gardner DM, Jacobs LM. Patient care activities by community pharmacists in a capitation funding model mental health and addictions program. BMC Psychiatry. 2018;18(1):192. https://doi.org/10.1186/s12888-018-1746-3
Jacobs L, Gardner D, Murphy A. Outcomes Evaluation of the Bloom Program. http://bloomprogram.ca/wp-content/uploads/2016/11/Bloom-Outcomes-Evaluation-Report-low-rez-Oct-14-2016.pdf (accessed Sep 4, 2021).
The Bloom Program. About the Bloom Program. https://bloomprogram.ca/about/ (accessed Sep 4, 2021).
Healthcare Management Advisors. Managing mental illness and promoting and sustaining recovery: the role of community pharmacy (final report). https://6cpa.com.au/wp-content/uploads/Managing-mental-illness-and-promoting-and-sustaining-recovery-Full-Final-Report.pdf (accessed Sep 4, 2021).
McMillan SS, Kelly F, Hattingh HL, Fowler JL, Mihala G, Wheeler AJ. The impact of a person-centred community pharmacy mental health medication support service on consumer outcomes. J Ment Health. 2018;27(2):164-173. https://doi.org/10.1080/09638237.2017.1340618
Wheeler AJ, O'Reilly CL, El-Den S, Byrnes J, Ware RS, McMillan SS. Bridging the gap between physical and mental illness in community pharmacy (PharMIbridge): protocol for an Australian cluster randomised controlled trial. BMJ Open. 2020;10(7):e039983. https://doi.org/10.1136/bmjopen-2020-039983
Australian New Zealand Clinical Trials Registry. Trial registered on ANZCTR (Registration Number: ACTRN12620000577910). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377483&isReview=true (accessed Sep 4, 2021).
Nielsen J, Young C, Ifteni P, et al. Worldwide Differences in Regulations of Clozapine Use. CNS Drugs. 2016;30(2):149-161. https://doi.org/10.1007/s40263-016-0311-1
Kitchener BA, Jorm AF, Kelly CM. Mental Health First Aid Manual, 4th ed. Parkville: Mental Health First Aid Australia; 2017. ISBN: 9780992310837
O'Reilly CL, Bell JS, Kelly PJ, Chen TF. Impact of mental health first aid training on pharmacy students' knowledge, attitudes and self-reported behaviour: a controlled trial. Aust N Z J Psychiatry. 2011;45(7):549-557. https://doi.org/10.3109/00048674.2011.585454
McCormack Z, Gilbert JL, Ott C, Plake KS. Mental health first aid training among pharmacy and other university students and its impact on stigma toward mental illness. Curr Pharm Teach Learn. 2018;10(10):1342-1347. https://doi.org/10.1016/j.cptl.2018.07.001
Boukouvalas E, El-Den S, Murphy AL, Salvador-Carulla L, O'Reilly CL. Exploring Health Care Professionals' Knowledge of, Attitudes Towards, and Confidence in Caring for People at Risk of Suicide: a Systematic Review. Arch Suicide Res. 2020;24(sup2):S1-S31. https://doi.org/10.1080/13811118.2019.1586608
El-Den S, Chen TF, Moles RJ, O'Reilly C. Assessing Mental Health First Aid Skills Using Simulated Patients. Am J Pharm Educ. 2018;82(2):6222. https://doi.org/10.5688/ajpe6222
Frick A, Osae L, Ngo S, et al. Establishing the role of the pharmacist in mental health: Implementing Mental Health First Aid into the doctor of pharmacy core curriculum. Curr Pharm Teach Learn. 2021;13(6):608-615. https://doi.org/10.1016/j.cptl.2021.01.027
McKee J, Mospan CM, Benfield M, Gillette C. A call for community pharmacists to complete mental health first aid training. J Am Pharm Assoc (2003). 2019;59(2):167. https://doi.org/10.1016/j.japh.2018.10.013
Kirschbaum M, Peterson G, Bridgman H. Mental health first aid training needs of Australian community pharmacists. Curr Pharm Teach Learn. 2016;8(3):279-288. https://doi.org/10.1016/j.cptl.2016.02.015
National Australian Pharmacy Students' Association. Position statement: mental health first aid education, https://home.napsa.org.au/news/position-statement-mental-health-first-aid-education (accessed Sep 4, 2021).
Gibson MR, Lott RS. Suicide and the role of the pharmacist. J Am Pharm Assoc. 1972;12(9):457-461. https://doi.org/10.1016/s0003-0465(16)32340-0
Mospan CM, Gillette C, McKee J, Daniel SS. Community Pharmacists as Partners in Reducing Suicide Risk. J Am Board Fam Med. 2019;32(6):763-767. https://doi.org/10.3122/jabfm.2019.06.190021
Murphy AL, Martin-Misener R, Kutcher SP, O'Reilly CL, Chen TF, Gardner DM. From personal crisis care to convenience shopping: an interpretive description of the experiences of people with mental illness and addictions in community pharmacies. BMC Health Serv Res. 2016;16(1):569. Published 2016 Oct 12. https://doi.org/10.1186/s12913-016-1817-4
Witry M, Karamese H, Pudlo A. Evaluation of participant reluctance, confidence, and self-reported behaviors since being trained in a pharmacy Mental Health First Aid initiative. PLoS One. 2020;15(5):e0232627. https://doi.org/10.1371/journal.pone.0232627
Carpenter DM, Lavigne JE, Colmenares EW, Falbo K, Mosley SL. Community pharmacy staff interactions with patients who have risk factors or warning signs of suicide. Res Social Adm Pharm. 2020;16(3):349-359. https://doi.org/10.1016/j.sapharm.2019.05.024
Murphy AL, O'Reilly CL, Ataya R, et al. Survey of Australian and Canadian Community Pharmacists' Experiences With Patients at Risk of Suicide. Psychiatr Serv. 2020;71(3):293-296. https://doi.org/10.1176/appi.ps.201900244
World Health Organisation. Suicide: WHO 2021. https://www.who.int/news-room/fact-sheets/detail/suicide (accessed Sep 4, 2021).
Australian Government National Mental Health Commission. The Fifth National Mental Health and Suicide Prevention Plan 2017. https://apo.org.au/sites/default/files/resource-files/2017/10/apo-nid114356-1220416.pdf (accessed Sep 4, 2021).
Productivity Commission. Productivity Commission, mental health, inquiry report. https://www.pc.gov.au/inquiries/completed/mental-health/report (accessed Sep 4, 2021).
Pharmaceutical Society of Australia. Productivity Commission on Mental Health Report. https://www.pc.gov.au/__data/assets/pdf_file/0008/250955/sub810-mental-health.pdf (accessed Sep 4, 2021).
World Health Organization. Live life: an implementation guide for suicide prevention in countries. https://apps.who.int/iris/rest/bitstreams/1350957/retrieve (accessed Sep 4, 2021).
Palombi L, Kading M, Hayes CJ. The public health pharmacist and the role of the pharmacy curriculum: A call to action. Curr Pharm Teach Learn. 2013;5(5):477-482. https://doi.org/10.1016/j.cptl.2013.06.011
Washington State Department of Health. Suicide Prevention Training for Health Professionals 2020. https://www.doh.wa.gov/ForPublicHealthandHealthcareProviders/HealthcareProfessionsandFacilities/SuicidePrevention/TrainingRequirements (accessed Sep 4, 2021).
Carpenter DM, Lavigne JE, Roberts CA, Zacher J, Colmenares EW. A review of suicide prevention programs and training policies for pharmacists. J Am Pharm Assoc (2003). 2018;58(5):522-529. https://doi.org/10.1016/j.japh.2018.05.004
Copyright (c) 2021 The Authors
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.