From the Executive Director

Penny Shelton, PharmD, BCGP, FASCP

Behavioral Health -- The Need is Great: Pharmacists, Can We Make a Difference?

A couple of weeks after ringing in the New Year, early on a Saturday morning, my phone rang. The ring was followed by news filled with a harsh and painful reality. Our neighbor’s oldest son had committed suicide. A young man we had watched grow up from across the street was forever lost to those who loved him. As the initial shock began to fade, I found myself thinking about how someone who seems to have so much to look forward to in life, how is it that he experienced only abject hopelessness? This young man, a soldier and recent college graduate with a new job and home, how did he become swallowed up by despair and agony, to such a degree that he was blinded to any solution other than ending his own life?

As I type this column, our nation is reeling in the aftermath of the Stoneman Douglas High School shooting in Parkland, Florida. Parkland will be another mass shooting forever etched as a dark mark in U.S. history. Seventeen lives were cut short due to the deranged actions of a young man, whose troubled past and signs of mental illness are only now, when it is too late, being examined for what could have been done to prevent the tragedy.

Of late, many of the meetings that I have attended have been related to the behavioral health aspects of substance use disorders. However, these meetings and the subsequent follow-up conversations have frequently turned to all things behavioral health, including unmet needs and lack of resources. The needs are great and seemingly everywhere!

Depression, anxiety, substance use disorders, and psychoses permeate much of the work of healthcare and pharmacy. Unfortunately, there is still a great deal of stigma related to mental illness. Most find it awkward and difficult to engage in conversations about behavioral health needs with their patients. For many, unless the patient asks, we tend to turn a blind eye to these issues. On the other hand, most healthcare providers, including pharmacists, show no hesitation in taking a proactive approach with patients about such conditions as hypertension and diabetes.

I believe there is more that pharmacists can do to help with mental illness. Pharmacists are strategically positioned to help bridge the gap between primary care and behavioral health. Pharmacists are underutilized in behavioral health, but with a concerted effort, this is a reality that we can change.

A few years ago, when I was serving as Associate Dean for Academic Affairs for the School of Pharmacy at Shenandoah University, I had the privilege of working with a number of amazing next-generation pharmacists. One of these students, who is now a pharmacist, found her path to pharmacy through a most unusual yet profound way. When she was in middle-school, she and her mother lived in fear of an alcohol-fueled step-father, who frequently physically abused her mother. One day, she and her mother were at a community pharmacy picking up some prescriptions. Her mother was wearing a pair of dark sunglasses, an all too often needed accessory, to hide her bruises. The pharmacist, when handing her the prescription bag, said something similar to: “I put some information in your bag for you. If I am wrong, then I apologize for my error, but if I am right and I did nothing, then that would be an even greater injustice.” The pharmacist had given her a brochure about domestic abuse and contact information for a community safe house for abused women. To this day, my ex-student credits that pharmacist, a stranger who cared enough to notice, with saving her mother’s life. The care and compassion of that pharmacist made a difference and left a lasting impression.

What if more pharmacists took on the simple act of reaching out with information or starting a conversation with individuals in need? What if pharmacists were equipped with the resources, skills and information to make the process of engaging in these delicate conversations less awkward? What if pharmacists provided patients with information about community resources for suicide prevention, domestic abuse, and substance use disorders?

NCAP, this past fall during our Annual Convention, provided a workshop on Mental Health First Aid. I’d like to offer NCAP as a mechanism for bringing this training to pharmacists regionally. Perhaps the Association can help develop tools and resources to help mobilize pharmacists for behavioral health intervention. I welcome your thoughts and comments. I’d like to know how you think pharmacists can make a difference. We will not be able to save everyone, but if we do nothing, then we perpetuate our underutilization as well as the current disparities in behavioral health.

Pharmacy Proud penny@ncpharmacists.org