Suicide
Charnicia Huggins, PharmD
Suicide rates in the United States are increasing among males and females, yet community pharmacists who regularly see and provide medications to those suffering with mental health conditions remain an untapped resource for risk reduction efforts, according to a commentary published in the Journal of the American Board of Family Medicine in November 2019.
To address this concern, Cortney M. Mospan, PharmD, BCACP, BCGP, and her coauthors compiled a list of best practices for integrating pharmacists into interdisciplinary suicide screening efforts while describing the associated challenges inherent in the process.
“Pharmacists are ready, and they’re capable. But it’s not something they’re often comfortable with,” Mospan, assistant professor of pharmacy at Wingate University School of Pharmacy and clinical pharmacist at Novant Health in North Carolina, told Pharmacy Today. “A lot of people need some additional training to bridge that gap from where they are right now,” she said.
The need for community pharmacists
From 1999 to 2017, the rate of suicide in the United States increased 33%, according to CDC’s National Center for Health Statistics. Other data show that more than one-half of victims did not have a prior mental health diagnosis.
Suicide currently ranks as the number 10 cause of death for all ages. It is the second and fourth leading cause of death among individuals aged 10 to 34 years and those aged 35 to 54 years, respectively.
In light of such unsettling statistics, Mospan and colleagues emphasized the need to involve community pharmacists in efforts to reduce suicide risk. They noted that more than one in three adults in the United States take medications that can cause depressive symptoms. In addition, almost 24% of patients take medications that list suicidal ideation as a potential adverse effect.
Community pharmacists, whom patients visit nearly 10 times more often than their primary care providers (PCPs), can monitor for mental health–related warning signs.
Overcoming barriers
Integrating pharmacists into suicide risk reduction efforts is not without its challenges, however.
Barriers include the need to identify the correct patients for screening, considering adults do not always recognize their symptoms as mental health related; lack of education and preparation for pharmacists; gaps in transitions of care; and inadequate use and recognition of pharmacists in nondispensing roles.
To overcome these potential obstacles, the authors noted that it is important to recognize that older adults are not routinely screened for suicidal ideation. They also recommended requiring evidence-based training for all pharmacists, developing triage processes from community pharmacies to PCPs, and having PCPs encourage patients to consider pharmacists as members of their mental health care team. The latter may require a shift in thinking among PCPs.
According to Amy Mullins, MD, medical director for quality and science at the American Academy of Family Physicians, “The concept of a health care team is not new, but having members in more nontraditional roles, like pharmacists, is new.”
Mospan and her coauthors propose that community pharmacists perform initial screenings and referrals to PCPs or to mobile crisis units, depending on the severity of the screening results. PCPs can then make formal diagnoses, initiate treatment, and ultimately link patients to mental health providers who can manage all of the patients’ mental health care needs.
Some pharmacists may underestimate the extent to which they are valued by other health professionals, Mospan noted. “Many providers are excited about this opportunity to spread the net, catch more people, triage them, and get them the appropriate care.”
“Pharmacists can bring a wealth of knowledge to the team, and some physicians are integrating pharmacists into their practices onsite,” Mullins added.
“What is more difficult is the integration of an offsite, community-based pharmacist. This relationship needs to be more intentional and takes more time (on both sides) to collaborate and communicate effectively.”