We will be reviewing and briefly discussing an article published in the The Journal of the American Board of Family Medicine earlier this month. The article is titled “Community Pharmacists as Partners in Reducing Suicide Risk”, and was written by Mospan, Gillette, McKee, & Daniel. The authors hit on a variety of important points regarding mental health, specifically those related to the rise in death by suicide. Importantly, the authors make note of the large percentage of individuals who die by suicide who were not previously diagnosed with a mental health condition (~54%). Lack of a formal mental health diagnosis could be attributed to social stigma or limited access to health care, and the authors of this study hone in on community pharmacists and the role they may play in the health care system.

What did they do?

The authors effectively and concisely highlight components of the pharmacist/patient relationship that make community pharmacists an integral component in early identification of individuals at risk for mental health issues, in this case, specifically suicidality.

Why did they do it?

As the authors clearly outlined, there is an up-and-coming positive mindset toward the importance of enlisting multiple healthcare providers at different points of access to help identify individuals who may be struggling with mental health issues. There is a growing collection of literature that supports the integration of primary care physicians (PCPs) into the world of mental health screening and treatment. PCPs are viewed as holding an important role in this process as they are often the members of the healthcare team who have contact with a patient prior to a suicide attempt. 45% of patients have contact with their PCP in the month prior to a suicide attempt.

While a large portion of individuals do in fact have contact with a PCP on a regular basis, the average patient only visits their PCP 4 times per year (per this article). Conversely, patients, on average visit their community pharmacist 35 times per year (per this article). Previous literature has also shown that community pharmacists are able to complete mental health screenings in practice and, therefore, could play a vital role in identifying patients at risk for engaging in suicidal behavior.

How did they do it?

The authors aimed to identify and compile a working list of best practices for interdisciplinary suicide screening. These best practices were based upon the most common challenges that non-mental health professionals in the medical field may encounter when working in a more mental-health setting and/or context.

What did they find?

The authors broke down their recommendations for interdisciplinary screening for suicide risk based on 4 challenges most commonly cited within the medical community: Patients to screen, lack of education and preparation, gaps in transitions of care, and role of the pharmacist. While these recommendations are not particularly specific in nature, they highlight important points that should be considered when structuring suicide screening procedures for health professionals outside of the mental health discipline.

  1. Patients to screen
    1. All adults (and children, as highlighted in some of our other blog posts) often do not recognize their symptoms as signs of mental health conditions.
    2. Common “risk factors” for determining suicide ideation risk may have limited clinical utility. Again, mental health does not discriminate. Just because someone appears to be “fine”, digging a little deeper could have a life saving impact.
    3. Older men are less likely to be screened for suicidality, though they represent a high risk group.
  2. Lack of education/preparation
    1. Washington state requires all health care providers to complete suicide prevention training. Moreover, the importance of this training is outlined by the National Strategy for Suicide Prevention.
    2. Inter-professional education at schools and colleges of pharmacy, medicine, etc. could incorporate mental health care and access into the curriculum.
  3. Gaps in transitions of care
    1. The development of transitions of care programs for post-emergency department discharge. This would help to communicate back to PCP, community pharmacist, and if established, mental health care provider.
    2. Adequate psychosocial assessment (at the very least) should occur in a multitude of health care settings to identify patients at risk as soon as possible.
    3. There is a need to develop a triage process from community pharmacy to PCP/ mental health care provider or crisis unit/acute care based on severity.
  4. Role of the pharmacist
    1. PCPs and other medical professionals should encourage patient perception of their pharmacist as a part of the (mental) health care team
    2. Further research investigating models of interdisciplinary care for siocode prevention at the level of the pharmacist.

What does it all mean (our take)?

In our opinion, this article touches on several extremely important points. Perhaps most importantly is leveraging an existing care structure to work mental health evaluation directly into the workflow. We realize that community care practitioners simply do not have lots of additional time to dedicate to more procedural changes, but what they do have is access to the population.

In our eyes, similar to the authors of this paper, this presents a wonderful opportunity for technology to meet patient accessibility. Let’s provide the technology to complete mental health evaluation/screening efficiently to providers who have the greatest access to the population. If we can accomplish this feat, the downstream effects have the potential to be substantial.

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