The role of pharmacy in mental health and wellbeing

COVID-19 and beyond

Context

21 Integrationhealthcareteam

The mental health and wellbeing of the population has become an urgent priority as the UK and the world battles the viral threat of COVID-19.

It's becoming clear that the toll of the pandemic is not merely physical. Illness and grief caused by the outbreak, together with isolation, economic instability and sudden and seismic changes to day-to-day life, has placed considerable strain on the population’s mental health 1. For example the number of adults experiencing some form of depression in Great Britain has doubled during the COVID-19 pandemic,2 according to figures from the Office of National Statistics.

The World Health Organisation (WHO) has stated that it is “crystal clear that mental health needs must be treated as a core element of our response to and recovery from the COVID-19 pandemic”3. Meeting this need will be a significant challenge for the NHS, requiring input from across health and social care sectors.

The Royal Pharmaceutical Society is clear that the pharmacy profession must be at the forefront of the efforts to support the nation’s mental health and wellbeing. As part of a co-ordinated, multi-agency, integrated approach, this will advance efforts towards greater parity of esteem between the care for physical and mental health and support the health of those impacted upon by the pandemic.

Among the most accessible of health professional groups, the public will continue to turn to pharmacists as a trusted source of advice. The profession’s expert input on medicines use will be a crucial component of the treatment of those requiring care for mental health conditions. It is critical that the pharmacy profession is equipped for the potential future surge of people with mental health and wellbeing needs and those who continue to struggle in the aftermath of the pandemic.

Purpose and aims

Aimed at a wide range of organisations and stakeholders including national governments and the NHS, this policy outlines the role pharmacists and pharmacy teams should play to meet mental health challenges in the short to medium term in response to the impact of COVID-19. It includes recommendations to enable the public to benefit from increased support and improved access to the expert skills and knowledge of pharmacists. This document defines the professional responsibility of each pharmacist when supporting people with mental health needs. It provides clarity and assurance to pharmacists, their health professional colleagues, patients and the public about the profession’s role in this important field of practise. Accompanying professional guidance and tools are available here to support the profession in fulfilling its responsibility.

1. Identifying people struggling with their mental health and wellbeing

Identifying new symptoms

While individual responses to the pandemic will differ, early identification of mental health issues and quick access to advice and care is vitally important. 4

Through vigilance and rapport with their patients and the public, pharmacists are well placed to identify changes in behaviour and early signs of mental health problems including anxiety, depression, post-traumatic stress disorder, and substance or alcohol abuse.

Community pharmacists and their teams interact with 1.6 million people every day. Conveniently located on high streets and in the heart of communities they are particularly important in the early detection of mental health and wellbeing problems. Careful monitoring of requests for over the counter medicines (e.g. anti- anxiety or sedative products, analgesics, and laxatives) and signs and symptoms identified during consultations can suggest a decline in a person’s mental health or wellbeing.

There is a close correlation between population groups who most frequently visit community pharmacies and those most vulnerable to poor mental health due to COVID-19. These groups include the elderly, those living in deprived areas, people with long term conditions and those receiving treatment for substance misuse. 5,6

Understanding the impact of bereavement and grief and the impact on individual mental health is also a key issue for community pharmacists, which is likely to be exacerbated by the pandemic and often presents as a crisis. 7

Identifying relapse and worsening of existing symptoms

The uncertainty of the pandemic may negatively impact on people with existing diagnosed mental health conditions and could be a contributory factor for relapse. As primary care and community pharmacists often see these people on a regular basis, they are ideally placed to recognise early signs and symptoms of relapse and worsening of existing symptoms. A pharmacist is best placed to provide support for people on regular medication, and signpost to relevant support or, if required, alert their GP to the need for specialist mental health support.

Being alert to mental health needs of people with COVID 19

Those who have been seriously ill and hospitalised due to COVID-19 are particularly vulnerable to mental health problems during the weeks and months of their recovery. 8 Hospital pharmacists should be alert to the risk of mental health problems both during their hospital stay and on discharge and prioritise them for transfer of care services, where available.

With patient consent, these services should alert the patient’s community pharmacist to their status upon discharge, allowing the community pharmacist to offer proactive support to the person and their family. This collaborative approach across pharmacy will ensure that pharmaceutical support is available throughout the patient’s journey.

Recommendation

The community pharmacy network must be involved in any local planning to identify and support people with their mental health and wellbeing.

Professional Responsibility

Pharmacists and their teams should be alert to any signs of declining mental health and wellbeing, particularly among high risk population groups 1,2 and use their professional judgment to take appropriate action.

2. Increasing Access to Support for People, including Signposting and Referral

Assessing the nature and severity of any symptoms of mental health problems is a critical step for the pharmacist before deciding on appropriate action. If the symptoms presented are mild the appropriate action may be to simply provide advice on positive behavioural change, lifestyle choices and self-care.

Referral to local wellbeing services, mental health specialist teams or social prescribing pathways are important actions that pharmacists can take. However, at present, pharmacists’ role in signposting and referral is typically informal and relies upon individual pharmacists, their knowledge of local services and personal relationships with local GPs and mental health teams.

As demand grows, the contribution of pharmacists in increasing access to mental health care and support must be maximised. This will require improving current informal ways of working into more structured referral systems and working practices.

Recommendation

Pharmacists should be able to increase and accelerate access to mental health and wellbeing support for those who require them:

    • To facilitate signposting, local authorities and health bodies should routinely share up-to-date information on national and local wellbeing services with community pharmacies in their locality
    • Formal systems must be in place to enable pharmacists to directly refer patients that require specialist mental health care to appropriate health professional colleagues.

Professional Responsibility

All pharmacists should ensure that they keep up to date with local and national support services in order to signpost or refer anyone who they have identified may benefit from those services.

3. Safe and Effective Use of Medicines

For those people using medicines to manage their mental health, non-adherence can be a challenge, especially for those with severe symptoms. Poor adherence can result in worse outcomes and can lead to the need for further intervention or even hospital admission. The expert medicines skills of pharmacists mean they are best placed to provide effective support.

When prescribed a medicine to help manage their mental health condition, people should always receive support and benefit from a pharmacist's expert medicines knowledge. Studies show that structured consultations services provided by community pharmacists, increases adherence to medicines. 9 Enabling such services to be delivered to patients prescribed a medicine for the first time to support mental health and wellbeing is likely to improve adherence for these people.

Recommendation

Steps should be taken to identify how pharmacists in all settings can be enabled to better support people with mental health problems with their medicines.

Every mental health team should have access to a specialist mental health pharmacist as a member of the multidisciplinary team, whether based in community teams, mental health hospital wards or acute hospitals.

Professional Responsibility

Proactive pharmacist support should be offered to all people who have newly been prescribed medicines to support their mental health and wellbeing.

4. Communication of diagnoses and prescribed medicines

Safe and Effective Use of Medicines Communication between healthcare professionals in different settings is crucial to reduce the risk of errors and ensure continuity of care. It is vital that all professionals inputting into the patient's care are aware of the diagnosis and suggested care pathway to provide the best care and advice for patients.

Pharmacists should have full read and write access to up to date patient health records to improve patient care and patient safety. Information is key to delivering more effective pharmaceutical care to patients, improving medicines adherence and reducing the medicine related errors which contribute to unplanned admissions to hospital.

It is well documented that transitions of care (e.g. from hospital to the person’s own home) can lead to unintended medication discrepancies1. The Discharge Medicines Review services available in Wales, Medicines Care and Review in Scotland and the Discharge Medicines Service in England should be further utilised for people with a mental health condition.

Recommendation

Mental health and hospital services should prioritise communicating with all relevant healthcare professionals working in primary care including community pharmacies, so that a collaborative approach to supporting people with mental health conditions is achieved in order to improve care and prevent re-admission.

All pharmacists directly involved in patient care must have access to IT systems that are interoperable with other primary care IT systems. This would include read and write access to a full and integrated electronic patient record, to allow pharmacists to fully support patients with mental health conditions.

Professional Responsibility

Pharmacists must support communication across health care settings and act on any information that is shared.

5. Training and Information

Training

Pharmacists and their teams need the knowledge, skills and confidence to effectively manage the challenges of mental health and the ongoing consequences of the COVID-19 pandemic. Protected learning time is essential to be in place for all pharmacists so that they have the time to refresh their skills in light of the pandemic and further embed into the multidisciplinary health team.

There must a co-ordinated approach of psychological first aid training and mental health first aid training to all pharmacists and their staff. This should include the principles of providing support to people/carers, as well as advice on the management of high-risk situations e.g. self-harm and suicide prevention.

As a trusted source of advice, pharmacists will have a key role in delivering accurate and up-to-date information and public health advice related to COVID-19. The overwhelming amount of information and conflicting advice seen during the pandemic can worsen mental health and wellbeing. Having access to good quality information about the virus can help people feel more in control. 10

Recommendation

Protected time should be in place for all pharmacists to learn new skills and update their knowledge as part of a multidisciplinary team to further support the mental health and wellbeing of their communities.

Professional Responsibility

As a professional, each pharmacist has a responsibility to maintain their knowledge and skills in order to support people with their wellbeing and mental health conditions. Pharmacists must keep up-to-date with the developments of COVID-19 to support and reassure the public.

6. Summary

The expertise and clinical knowledge of pharmacists must be fully utilised, working collaboratively with other health and social care professionals, to support people with mental health problems and ensure they live longer and healthier lives.

The Royal Pharmaceutical Society is committed to working with the NHS and its other partners to drive this important agenda forward and to evaluate its effectiveness in improving patient care.

Reference

1 Fancourt, D et al. 2020. Covid19 Social Study - Understanding the psychological and social impact of the pandemic.
Available at: https://www.covidsocialstudy.org/

2 office for national statistics. 2020. coronavirus and depression in adults, great britain: june 2020.
Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/articles/coronavirusanddepressioninadultsgreatbritain/june2020

3 World Health Organisation. 2020. Substantial investment needed to avert mental health crisis.
Available at: https://www.who.int/news-room/ detail/14-05-2020-substantial-investment-neededto-avert-mental-health-crisis

4 National Institute for Health and Care Excellence. 2019. NICEimpact mental health.
Available at: https://www.nice.org.uk/media/default/ about/what-we-do/into-practice/measuringuptake/niceimpact-mental-health.pdf

5 Gunnell D, Appleby L, Arensman E, Hawton K, John A, Kapur N, et al. Suicide risk and prevention during the COVID-19 pandemic. Lancet Psychiatry (2020) 7(6):468–71. doi: 10.1016/s2215-0366(20)30171-1

6 Chiappini, S., Guirguis, A., John, A., Corkery, J., Schifano, F. COVID-19: The hidden impact on mental health and drug addiction. Frontiers in Psychiatry. 10, 767: 1-4. doi: 10.3389/fpsyt.2020.00767.
Available at: https://www.frontiersin.org/ articles/10.3389/fpsyt.2020.00767/full

7 Murray, B. & Stein, P. 2020. Coronavirus Disease 2019 (COVID-19): Psychiatric illness.
Available at: https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-psychiatric-illness

8 NHS England. 2020. After-care needs of inpatients recovering from COVID-19.
Available at: https://www.cambscommunityservices.nhs.uk/docs/default-source/luton-adults-general/c0388_after_care_needs_of_inpatients_recovering_from_covid-19_5_june_2020.pdf

9 Mantzourani E, Hodson K, Way C, Andrew E. 2020 The Discharge Medicines Review Service in Wales: What is it and what are the benefits? International Pharmacy Journal, vol 38, no1, pp34-37.
Available at https://lnkd.in/eHitMXC

10 Mental Health Foundation. 2020. Looking after your mental health during the coronavirus outbreak.
Available at: https://www.mentalhealth.org.uk/coronavirus/looking-after-your-mental-healthduring-coronavirus-outbreak