The role of pharmacy in mental health and wellbeing

COVID-19 and beyond

Context

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.

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.

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.