Mental Health
Loren Bonner
The fragility of our mental health has never been more exposed than during the COVID-19 pandemic. Crisis hotlines have seen enormous spikes in call volumes. According to an analysis by Express Scripts, prescriptions jumped 34.1% for antianxiety medications and 18.6% for antidepressants between February 16 and March 15.
For pharmacists, the toll on patients’ mental health has been a shapeshifting experience.
Nathan Painter, PharmD, CDCES, FADCES, who works as an ambulatory care pharmacist in family medicine at UCSD Family Medicine Clinics, said he’s needed to do extra as a pharmacist. “I can be more deliberate about the depression and anxiety screens [Patient Health Questionnaires 2 and 9], and I focus more on self-care strategies,” he said. Painter has even spoken to patients about meditation and relying on their faith, often framing the discussion around what they can do during this time.
He’s had to be flexible and work with patients on an individual basis, too. “We can’t say one size fits all, especially during this,” said Painter. He asks open-ended questions and has to be receptive to what patients are experiencing, which goes back to putting the patient at the center of their care.
Relying on pharmacists for information
Patients have continued to come into pharmacies, which are deemed essential businesses, during the COVID-19 pandemic. A May survey from the Alliance of Community Health Plans found that 49% of respondents said they felt “very comfortable” picking up prescriptions at their pharmacy and speaking with a pharmacist. A lack of access to physicians during this time has also led patients to rely more on their pharmacist. Many patients have questions.
“People are calling and wanting information,” said Clark Bishop, PharmD, a partner and pharmacy manager at Hutton Pharmacy in Blackwell, OK.
Clark has noticed elevated levels of anxiety in patients. He said one of the best things they’ve been able to do is manage patients’ fear by providing accurate information and being an honest, reliable voice of reason.
Talia Puzantian, PharmD, BCPP, professor of clinical sciences at Keck Graduate Institute in Claremont, CA, said she tells pharmacists and student pharmacists that worry and anxiety are typical reactions to these circumstances.
The key is understanding when a patient’s anxiety is normal and when it requires a referral. If anxiety is preventing a patient from doing essential duties, such as taking care of loved ones or oneself, a referral is likely necessary, Puzantian said.
“Acknowledge that it’s a tough time, and give people an opportunity to talk to determine if they need more help or not,” said Puzantian. Pharmacists should have resources at their fingertips in case they need to refer the patient for further assistance.
“Having a pharmacist just being able to identify someone who is struggling and referring them is critical,” she said.
Everyone reacts differently to stressful situations
A person’s response to the COVID-19 pandemic can depend on their background, social support from family or friends, financial situation, health and emotional background, and more.
According to CDC, people who may respond more strongly to the stress of a crisis include people who:
- Are at higher risk for severe illness from COVID-19 (for example, older people and people with underlying health conditions)
- Are children and teens
- Are caring for family members or loved ones
- Are frontline workers such as health care providers and first responders, retail clerks, and others
- Are essential workers who work in the food industry
- Have existing mental health conditions
- Use substances or have a substance use disorder
- Have lost their jobs, had their work hours reduced, or had other major changes to their employment
- Have disabilities or developmental delay
- Are socially isolated from others, including people who live alone, and people in rural or frontier areas
- Are in some racial and ethnic minority groups
- Do not have access to information in their primary language
- Are experiencing homelessness
- Live in group settings
More information and helpful resources on coping with stress during COVID-19 can be found on CDC’s website.
Mental Health First Aid
Many pharmacists want to help, but don’t know how to.
Puzantian has been training pharmacists all over the country in Mental Health First Aid. She said this training raises awareness, reduces stigma, and gives pharmacists the vocabulary and confidence to help.
The baseline of Mental Health First Aid training is understanding the signs and symptoms of mental illness and addiction and learning how to help someone in distress.
The trainee is given tools to be able to identify when an individual is experiencing a mental health issue or crisis and to start the intervention process, which includes referring them for additional help.
Mental Health First Aid was originally created in Australia and came to the United States about a decade ago with help from the National Council for Behavioral Health.
Although pharmacy-specific courses are available within the training curriculum, anyone can be trained in Mental Health First Aid—they do not have to be a heath professional.
Due to the increased demand for mental health resources during the COVID-19 pandemic, Walgreens announced in May that it completed the first phase of training all of the company’s health outcomes pharmacists in Mental Health First Aid.
“Every day, in communities across America, our pharmacists are talking with patients with a wide range of conditions, including mental health,” said Rina Shah, Walgreens group vice president for specialty and retail pharmacy operations, in a statement.
“With the prevalence and rise of incidents of depression, anxiety, addiction, PTSD, and others, specialized training can be key to identifying warning signs, and working with other providers, even finding gaps in care or treatment. We’ve long believed pharmacists can play an even greater role as part of patients’ care teams, and we’re proud to be at the forefront of our industry expanding our efforts in the area of mental health to help meet this growing need.”
Walgreens said Mental Health First Aid will become available to any pharmacist industry-wide this summer, along with the opportunity to earn continuing education credits through APhA.
The National Community Pharmacists Association offers credit to pharmacists who complete Mental Health First Aid training, regardless of whether it’s taught by a pharmacist or other community member.
The National Council for Behavioral Health has announced a virtual Mental Health First Aid course during which trainees complete a 2-hour, self-paced class, and then participate in a 4-hour, instructor-led class using videoconferencing technology. More information can be found at mentalhealthfirstaid.org.