In-person contact is one of the best ways to reduce existing stigma toward patients with mental illness in the field of pharmacy, according to research presented at the American Association of Colleges of Pharmacies’ Virtual Pharmacy Education 2020 conference.

The issue of stigma toward patients with mental illness in pharmacy is of particular relevance due to the number of patients in the United States who have been diagnosed with a mental illness. Charles Caley, PharmD, BCPP, professor and chair of the Department of Pharmacy Practice at the Western New England University of College of Pharmacy and Health Services, explained during the presentation that 1 in 5 adults in the United States experience a diagnosable mental illness each year.

“In 2017, there were 17 million adults with major depression, 8 million with bipolar disorder, and 3 million with schizophrenia. Suicide, which is an important corollary to these illnesses, is the second leading cause of death for people aged 10 to 34, and the tenth leading cause of death overall. In 2018, there were 48,344 deaths by suicide,” Caley said during the presentation.

With 1 in every 6 adults filling at least 1 prescription for psychiatric medication, pharmacists are regularly engaging with these patients as a daily part of their practice. In this way, pharmacists have a significant role in these individuals’ experience of their health care team and have the ability to be a critical source of care for them.

Pharmacists are also able to engage in other opportunities to serve patients with mental illness when providing medication management services. These options include screening for depression, suicide prevention, providing smoking cessation services for patients with serious mental illness, and addressing comorbid medical illnesses, many of which are cardiovascular in nature, in patients with mental illness, according to the presentation.

Although academic pharmacy recognizes the importance of psychiatric pharmacotherapy in pharmacy curricula, the delivery of the educational content on the subject has often left very little time to discuss or practice listening, empathy, compassion, communication, and support for patients with mental illness. These soft skills are necessary for pharmacists to successfully engage with patients with mental illness, and are currently lacking from most pharmacy curricula, according to Caley.

For example, students in a pharmacotherapy didactic course might learn about which antidepressants are preferred for patients with post-partum depression, but these students would not learn how to successfully interact with a new mother who has been diagnosed with this illness, Caley said.

Additionally, students are not trained in how to support new mothers diagnosed with post-partum depression in their efforts to achieve remission so that they can bond optimally with their infants, Caley said. He noted that it can be argued that patient engagement is just as important as proper drug therapy selection in this regard.

An issue at play in the engagement level of pharmacists with patients with mental illness is the stigma that exists within the pharmacy field. Mental illness stigma can be understood as a negative attitude that one person has toward another person, and it is often triggered by some marker of a mental illness that a patient has, Caley explained. Such markers may be whether the patient exhibits hallucinatory behavior, or the fact alone that the patient is being treated with clozapine, an antipsychotic medication.

“Ultimately, when stigma is being expressed, discrimination is the result,” Caley said during his presentation. “If it in turn affects a patient’s drug therapy, such as causing nonadherence or large gaps in treatment, then the patient is at an increased risk for poor treatment outcomes, such as rehospitalization, declining physical health, and early death.”

Caley noted that although pharmacists who display such a stigma may not be doing so intentionally, such acts remain a clear violation of the oath of a pharmacist.

Stigma in pharmacy practice can present itself in many ways, Caley explained. Studies conducted on the subject have shown some of the ways in which stigma commonly appears.

Researchers have been able to identify that pharmacists with mental illness stigma may have negative attitudes toward hospitals for patients with mental illness; may feel more uncomfortable about discussing symptoms and medications for mental illness than for cardiovascular diseases; may have more negative views of patients with schizophrenia than patients with depression; may have negative attitudes towards patients with addictions; and may not feel comfortable or confident about their skills when engaging with patients with mental illness.

Additionally, studies have shown that patients with mental illness may receive less pharmacy services than patients with cardiovascular disease due to the existence of these stigmas.

Caley explained that the origins of stigma may lie in what the pharmacy curricula is not offering students. Specifically, studies have shown that the most valuable method of diminishing stigma is through in-person contact, Caley explained.

“With this knowledge, we have an opportunity and an obligation to begin doing our best to eliminate stigma from practice,” Caley said. “Academic pharmacy has an important role to play.”

REFERENCE
Caley C, Cates M, Harris S, Bostwick J, Goldstone L. De-Stigmatization of Mental Health Conditions—Considerations for U.S. Pharmacy Curricula. Presented at: American Association of Colleges of Pharmacy’s Virtual Pharmacy Education 2020; July 13, 2020; Virtual. virtualpharmed2020.aacp.org/meetings/virtual/qijQS6LK8xtkvTzPu. Accessed July 31, 2020.