Study Evaluates Confidence, Reluctance, and Self-Reported Behaviors After Pharmacy Mental Health First Aid Training


Training gives pharmacy staff the tools needed to initiate uncomfortable conversations about mental health and substance use issues.

Mental Health First Aid (MHFA) is a course by the National Council for Behavioral Health designed for non-mental health care professionals to provide the knowledge and skills needed to identify, understand, and help people in distress with mental health and substance-use issues. This training gives people the tools needed to initiate uncomfortable conversations about mental health and substance use issues, dispelling stigma and myths through education, and providing people with an action plan to identify and connect people to care during a crisis.

The 5-step action plan involves:

  • Assessing for the risk of self-harm or suicide
  • Listening non-judgmentally
  • Giving reassurance and information
  • Encouraging appropriate professional help
  • Promoting self-help and support strategies

Approximately 20% of individuals in the United States experience a mental illness annually, with less than half receiving treatment. In many parts of the United States, there are substantial gaps in access to mental health care due to the lack of mental health care providers. The COVID-19 pandemic has added further stressors due to isolation, loss of employment, and exacerbated barriers to care that may negatively impact those battling mental illness,

More than 90% of the US population live within 5 miles of a community pharmacy. Community pharmacists and pharmacy technicians are accessible and trusted health care professionals who could help recognize patients experiencing mental health crises linking them to much-needed care.

“As one of the ways to address mental health care access concerns in Iowa, an ad hoc committee examining these issues recommended provision of MHFA training to pharmacists,” said Anthony Pudlo, PharmD, MBA, vice president of Professional Affairs for the Iowa Pharmacy Association (IPA). Pudlo and a colleague attended a 5-day training session to become accredited to conduct MHFA training sessions.

At the same time, the National Community Pharmacy Association (NCPA), funded by a grant from the Community Pharmacy Foundation (CPF), partnered with the National Council for Behavioral Health to create an 8-hour adult MHFA training course providing pharmacy-specific cases with continuing pharmacy education (CPE) credit for pharmacists and pharmacy technicians.

This led to a collaboration between the NCPA, the IPA, the CPF, and Matthew Witry, PharmD, PhD, assistant professor at the University of Iowa College of Pharmacy, Department of Pharmacy Practice and Science/Division of Health Services Research to evaluate the success of the community pharmacy MHFA training initiative.

Pudlo, his colleague, and 3 other CPF grant-funded pharmacists who received train-the-trainer MHFA certification facilitated in-person MHFA training events in 2018. More than 200 pharmacists, pharmacy faculty, pharmacy students, and pharmacy technicians in Iowa, California, Florida, Indiana, and Oklahoma received MHFA training.

An electronic survey disseminated via email to participants 6 to 18 months after MFHA training assessed reluctance and preparedness to engage in MHFA behaviors, reported use of MHFA behaviors since being trained, and provided an area for open-ended comments.

Ninety-eight out of 227 participants responded, with more than 80% agreeing that MHFA training increased their preparedness to respond to a mental health crisis. Fifty-seven participants strongly disagreed with the statement that “I am too busy to provide MHFA at work.”

Most respondents strongly agreed they were confident they could offer basic MHFA information (54%) and could encourage someone to seek professional help (64%) experiencing a mental health crisis.

Results of the study also indicated that most respondents used MHFA skills after training. The majority of participants asked someone about their distressed mood (82%), with 28% asking on 4 or more occasions. Forty-four percent of respondents asked whether someone was considering suicide and 61% referred someone to resources.

Witry was encouraged by the results, expecting participants to discuss more barriers. Although time constraints were a challenge, they were not a barrier.

“Time is a factor” but “not an excuse for not stepping up when needed,” an open-ended response stated. Pudlo suggested that the pharmacy technician can triage a patient in need to the pharmacist for further assessment.

“If pharmacies want to implement MHFA, they need to work to dismantle excessive workload and privacy barriers,” Witry said.

After seeing the success of the MHFA initiative, 4 of the trainers collaborated to create a toolkit for pharmacy trainers as a guide for best practices implementation for other pharmacy groups. IPA is currently developing virtual MHFA training to launch in 2021 during the COVID-19 pandemic.

Since preliminary data demonstrated the initial effectiveness of MHFA training regarding confidence and using learned behaviors, there are plans to expand the initiative to other states to conduct a more robust analysis, according to Witry.

MHFA training empowers pharmacists and pharmacy technicians to encourage people to get the help they need and potentially save lives. Pudlo said this as an opportunity for pharmacists and pharmacy technicians “to take the first step to be the difference.”

Witry also recognizes that “people in health care are dealing with a lot of stress, especially these days. It is important to remember to fill our own cup and take care of ourselves.”

The Community Pharmacy Foundation (CPF) funds innovative ideas to advance the practice of pharmacy in the community setting. CPF is committed to transforming community-based pharmacy practice beyond filling prescriptions to a focus on providing patient care as a founding sponsor of the national Flip the Pharmacy program.

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