In the United States, one in five people suffer from a mental illness. Nearly half of Americans will experience a mental health crisis in their lifetime. And if those numbers aren’t troubling enough, less than half of the people who had a mental disorder in the past year received professional help.
These were the statistics before a pandemic swept through the country and upended all facets of life, including vital social connections and access to care. In August of 2020, the Centers for Disease Control and Prevention reported that the number of people with an adverse mental health condition doubled from 20 percent to 40 percent, mainly driven by rising rates of depression and trauma.
Pharmacists aren’t the first professionals that come to mind when thinking of mental health issues. But they are uniquely positioned to benefit those in need, particularly the 55 percent who never seek care. “Pharmacists have more eyes on patients than any other healthcare provider,” said Hannah Fish, PharmD, director of strategic initiatives at the National Community Pharmacist Association (NCPA). “They are going to notice changes in their patients because they’re seeing them more often and because of their highly trained medical background. They are that perfect bridge to open the door for a patient to talk to someone and get the level of referral that’s needed.”
The way for pharmacists to be the bridge, Fish said, is to take the national Mental Health First Aid (MHFA) training, an eight-hour course on how to identify and respond to signs of mental illnesses and provide initial help and support to someone who may be developing a mental health problem or experiencing a crisis. “Look for a course, then get trained and train your staff,” she said. “The skills are crucial right now, especially during this time when everyone is at their wits’ end and probably experiencing some sort of mental health problem.”
When Clark Bishop, pharmacist and owner of five independent pharmacies, attended the training for the first time, it turned his worldview upside down. Like many others who have taken the training, he discovered how much of his thinking had been driven by social stigma and misunderstandings. “It dispels a lot of the misconceptions of the common person,” he said. “It’s a complete change of how you treat mental health issues.”
Pharmacy’s role in mental health
Pharmacists aren’t expected to provide mental health services, or to even diagnose mental health illnesses. “It’s really more about providing support for someone who might be undergoing an acute mental health crisis, in which case they need to be referred to additional help,” Fish explained.
While CPR is triage for the body, MHFA is triage for the mind. You see a person collapse with a heart attack, you try to resuscitate until the ambulance arrives and takes over. Much the same, you see a patient hyperventilate from a panic attack during an immunization, you support them during the crisis, and then direct them to professional care.
In Bishop’s experience as a certified MHFA trainer, pharmacists say they have encountered the opportunity to provide mental health first aid far more often than CPR. And Bishop has personally found almost no limit to the applications of the training in his pharmacy. “There are examples every week I could go through. I use parts of it every single day.”
Bishop has trained his staff in MHFA at all five of his pharmacies, teaching them how to have conversations with patients and recognize needs. “We’re arguably the most accessible healthcare provider,” he said. “Someone can walk into our pharmacy and visit with a staff member when they’re struggling, and we can use our tool to help them.”
The tool Bishop refers to is ALGEE, an acronym for a series of actions to perform when you encounter someone developing or experiencing a mental health crisis. The gist is to approach them and assess their health, listen nonjudgmentally, and encourage them to get help. Fortified with the knowledge from the in-depth MHFA training, staff members can use ALGEE as a shorthand reference to confidently navigate the whole spectrum of mental health crises. “You can apply those five steps to any situation in the pharmacy,” said Fish.
The final Es in the acronym refer to two different kinds of encouragement, personal or professional, based on the level of care they need. “If it’s something mild, can you encourage someone to get exercise or do some meditation or some of the general best practices?” Fish explained. “If we’re dealing with a mental health disorder, then we encourage professional help: Do you need to see a counselor or a doctor?”
Bishop’s staff uses a couple of methods to recognize when a patient might need aid. First, a patient’s medication profile—looking out for antidepressants, in particular. Second, watching for dramatic changes in behavior or mood.
This is one area where independent community pharmacists show their unique value in mental health first aid—they know their patients well enough to identify when something is amiss.
And because the staff has relationships with the patients, it makes patients more open and receptive to the next step in the first aid response: asking them directly if they are thinking of hurting themselves or someone else.
“The first couple times are extremely difficult. You’re terrified when you do it,” Bishop said. “But once you get into a rhythm of doing it, it becomes second nature. I probably subconsciously do the five steps of mental health first aid all throughout the day at different periods without even realizing it.”
The ALGEE Action Plan
ASSESS for risk of suicide or harm.
Try to find a suitable time or place to start the conversation with the person, keeping their privacy and confidentiality in mind. If the person does not want to confide in you, encourage them to talk to someone they trust.
Many people experiencing a challenge or distress want to be heard first, so let the person share without interrupting them. Try to have empathy for their situation. You can get the conversation started by saying something like, “I noticed that …” Try to be accepting, even if you don’t agree with what they are saying.
GIVE reassurance and information.
After someone has shared their experiences and emotions with you, be ready to provide hope and useful facts.
ENCOURAGE appropriate professional help.
The earlier someone gets help, the better their chances of recovery. So, it’s important to offer to help this person learn more about the options available to them.
ENCOURAGE self-help and other support strategies.
This includes helping them identify their support network, programs within the community, and creating a personalized emotional and physical self-care plan.
For Bishop, the key to it all is using your ears more than your mouth. “Mostly what I do for mental health first aid is listen,” he said, “because a lot of these people haven’t had an opportunity to have someone listen to them in a long time. You’d be shocked at the response you get from the patients.”
Even if they don’t want to talk, you’ve still opened a door. “They now realize that somebody else is capable of seeing that they’re going through something and cares enough to ask them,” Bishop said. “Now that the door is open, they become much more willing to talk to you.”
To make mental health first aid effective, it takes more than the pharmacist. The national curriculum is designed for the layperson, so it’s just as accessible to your clerks as it is to your pharmacists. In addition to being more helpful to patients, having your staff trained helps with workflow by allowing the pharmacists to stay behind the counter when necessary.
Right now, pharmacies can only bill for mental health first aid services through a collaborative practice agreement with a prescriber, but Bishop hopes that will change in the future. “We have to figure out documentation on e-care plans, get the data, and show the money these third parties are saving before it will become completely reimbursed.”
After he received the training, Bishop applied what he learned to his pharmacy. “I immediately saw a complete culture shift inside of my store because it started changing the way we actually dealt with our patients,” he said.
At Bishop’s pharmacy, the staff used to play a game. Whenever a certain difficult and talkative patient called, everyone put their finger to their nose. The last one to do it had to take the call. “What I didn’t realize at the time is that it was having a huge impact on how we treated all patients,” Bishop said. “I got the training, it completely changed my perspective on what this person is going through. I no longer think of it as somebody who’s crazy or nuts or lost their marbles. I think there’s somebody who’s dealing with a mental health issue but is capable of being made well.”
Then Bishop trained his entire staff in mental health first aid, and now his employees race to be the first to answer when that difficult patient calls. “They know the kind of impact they can make because they have this new tool,” he said. “They are no longer scared of this person or worried about not being able to help them.”
In the lobby of the pharmacy, there’s a white board hanging on the wall. They call it the Community Hope Board. “We invite members of the community to share their victories here and what they have hope for,” Bishop said. “Once a few people start writing, it just takes off and I have to erase it and start all over again because so many people are sharing. It’s amazing.”
From the Magazine
This article was published in our quarterly print magazine, which covers relevant topics in greater depth featuring leading experts in the industry. Subscribe to receive the quarterly print issue in your mailbox. All registered independent pharmacies in the U.S. are eligible to receive a free subscription.
More articles from the December 2021 issue:
- Artificial Intelligence: Will Machine Learning Revolutionize Retail Pharmacy?
- Pharmacy Relief Agencies: How to Get Through Staff Shortages
- Risk Management Strategies for Small Businesses
- This Community Pharmacy Personalizes Patient Care Down to DNA
- National Retail Trend: Creating Your Own Brand of OTC Products
- Best Practices for Front-End Pharmacy Shelving
- Mental Health First Aid: Why Every Pharmacist Should Take the Training
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