Mental health first aid (MHFA) courses are training more pharmacists to recognize patients in crisis. This type of training may be critical for saving lives, and it is becoming an increasingly important part of pharmacy education.

Data on mental health in the United States and Australia were recently presented at the American Association of Colleges of Pharmacy (AACP) Annual Meeting’s Virtual Pharmacy Education 2020. The session also offered insights into training programs for pharmacy students about mental health first aid.

AACP meeting presenters from Washington State University (WSU) and the University of Sydney (USYD) shared statistics for pharmacist interactions with patients at risk for suicide. In Australia and Canada, 85% of pharmacists had interacted on the job with someone at risk of suicide, and 16% had had 6 or more such interactions.

In the United States, 22.4% of pharmacists knew a patient who died by suicide, and 21.6% knew a patient who requested a lethal medication dose.1 In both the United States and Australia, the rates of suicide are increasing. Globally, 800,000 people die by suicide annually, and suicide is one of the top 10 causes of death in people aged 15 to 49 years, according to the presenters. The United States saw a 31% increase in the suicide rate between 2001 and 2017, and Australia’s suicide rate increased by 9% from 2016 to 2017.1

“I think we can do better. We can decrease the number of people [who] die by suicide,” said panelist Anne Kim, PharmD, MPH, MIT, assistant professor of pharmacotherapy at Washington State University.

The data also showed that of people who died by suicide, 69.67% in the United States and 75% in Australia were male.1 According to Kim, men are more likely to die by suicide because men tend to use more lethal means. Women are more likely to attempt suicide, she added.

For undergraduate students in the United States, the rates of suicide ideation and suicide attempts increase with exposure to stress. According to Kim, these stress exposures include life-changing events, such as the death of a loved one, a breakup with a significant partner, or a change in career path. The data showed that suicide attempts for students with 0 stress events were 3.3% in 2018, and that percentage increases with each additional stress event. Students with 6 or more stress events had a 21.1% rate of suicide attempts in 2018.1

Rebekah Moles, PhD, BPharm, associate professor of pharmacy practice at USYD, said the statistics demonstrate how important it is that pharmacists undergo training to recognize a mental health crisis and to take action for improving patient outcomes. “As health care professionals, we have plenty of opportunities to intervene,” she said.1

MHFA assists people who are developing a mental health problem, experiencing the worsening of a mental health condition, or in crisis. In addition to suicide, mental health crisis situations include panic attacks, psychosis, and depression.1 MHFA is to be provided until professional help is received or the crisis is resolved.2

Sarira El-Den, PhD, MIPH, BPharm, a lecturer at USYD, cited Australia’s MHFA action plan, called ALGEE, as a model. The ALGEE plan is also utilized in the United States and includes:1
  • Approach, assess, and assist with any crisis
  • Listen and communicate nonjudgmentally
  • Give support and information
  • Encourage appropriate professional help
  • Encourage other supports

In 2016, Washington became the first state to require pharmacists to complete suicide awareness and prevention training to address the public health issue. Four years later, MHFA and suicide intervention training are now incorporated into the curricula at WSU’s College of Pharmacy and Pharmaceutical Studies.2

A big part of this training is to move a future pharmacist from being hesitant to address a mental health issue to taking action. Students are also trained to be aware of their own mental health needs.2

“We have students get acquainted with resources in their local communities,” said Damianne Brand-Eubanks, PharmD, assistant professor of pharmacotherapy and director of Student Success at WSU.

The 2-credit elective MHFA course is offered to PY2 and PY3 students at WSU.

“They come in with a baseline understanding of the disease states. We help them become more aware of the stigma that they themselves carry, whether they know it or not,” said Kim.

Thus far, the course has proven to be popular, according to Brand-Eubanks. “The classes reach capacity with a waitlist,” she added.

According to El-Den, in Australia, at least one-third of pharmacy schools offer MHFA courses to pharmacy students.1 “At the University of Sydney, we have embedded standard mental health training into [degree programs],” she said.

El-Den said USYD offers MHFA for BPharm and MPharm degree candidates, and the courses are open to the public as well. The university is continually coming up with new simulated case studies to keep students engaged and informed.1

In addition to pharmacy schools, some professional organizations are offering opportunities for pharmacists to learn about MHFA and obtain certification through continuing education. These organizations include the National Community Pharmacists Association, the Iowa Pharmacy Association, and the American Pharmacists Association (APhA), which made MHFA a policy topic in 2019.3 Additionally, Walgreens collaborated with APhA and the National Council for Behavioral Health in 2019 to provide MHFA training to many pharmacists and other team members within the company.4

El-Den said the MHFA training does lead to improved outcomes.1 At WSU, assessments conducted by instructors show that student pharmacists gain confidence in recognizing suicide warning signs in patients, as well as in coworkers, family members, and friends.2


REFERENCES
  1. El-Den S, Moles R, Robinson J, Kim A, Brand-Eubanks D. Mental health first aid: increasing student pharmacist preparedness to respond through simulation. Presented at: American Association of Colleges of Pharmacy (AACP) Annual Meeting, Virtual Pharmacy Education 2020; July 22, 2020; Accessed August 3, 2020.
  2. Coppock K. Program offers training in suicide prevention and awareness. Pharmacy Times®. July 18, 2019. Accessed August 4, 2020. https://www.pharmacytimes. com/conferences/aacp-2019/program-offers-training-in-suicide-awareness- and-prevention
  3. Wells SM. Pharmacists on the front lines with mental health first aid. Mental Health First Aid. December 13, 2018. Accessed August 27, 2020. https://www.mentalhealthfirstaid. org/2018/12/pharmacists-on-the-front-lines-with-mental-healthfirst- aid/
  4. Walgreens forms unique collaboration with the National Council for Behavioral Health and American Pharmacists Association to offer mental health first aid training for pharmacists and team members. Walgreens. May 1, 2019. Accessed August 27, 2020. https://news.walgreens.com/press-releases/general- news/walgreens-forms-unique-collaboration-with-national-council-for-behavioral- health-and-american-pharmacists-association-to-offer-mental-health-first-aid-training- for-pharmacists-and-team-members.htm