Detecting and dealing with suicidal patients in the pharmacy

A scoping review of community pharmacists and patients at risk of suicide

Background

Medications are commonly used in suicide attempts. Pharmacists are inextricably linked to medications and may have roles in helping those at risk of suicide. We conducted a scoping review to characterize the existing literature and make recommendations about future research.

Methods

We used a 6-step approach based on an existing scoping review methodological framework, including identifying the research question; identifying relevant studies and other literature; study and literature selection; data charting; collating, summarizing and reporting results; and dissemination of results. We searched electronic databases, various grey literature sources and mobile app stores.

Results

Thirty-five articles were included following screening of 1013 database citations. Of 1085 results from grey literature searches, we included 12. Most publications were opinion pieces (n = 22), followed by survey studies (n = 9), primarily assessing pharmacists' knowledge and attitudes. Themes included education and training to impact knowledge and attitudes, gatekeeping of medication supply, collaboration and integration, and role perception. Public perspectives on pharmacists' roles were limited.

Conclusions

Research regarding pharmacists' roles in the care of people at risk for suicide is limited. The areas that have dominated the literature include legal liability, especially with respect to gatekeeping medications, ethical decision making and education and training. Research is needed to determine what methods, outcomes and measures are required to best serve in building the evidence base for policy and practice decisions in this area.

From personal crisis care to convenience shopping: an interpretive description of the experiences of people with mental illness and addictions in community pharmacies

BACKGROUND

The role of community pharmacists is changing globally with pharmacists engaging in more clinically-oriented roles, including in mental health care. Pharmacists' interventions have been shown to improve mental health related outcomes but various barriers can limit pharmacists in their care of patients. We aimed to explore the experiences of people with lived experience of mental illness and addictions in community pharmacies to generate findings to inform practice improvements.

METHODS

We used interpretive description methodology with analytic procedures of thematic analysis to explore the experiences of people with lived experience of mental illness and addictions with community pharmacy services. Participants were recruited through multiple mechanisms (e.g., paper and online advertisements), offered honorarium for their time, and given the option of a focus group or interview for participation in our study. Data were gathered during July to September of 2012. Interviews and focus groups were audio-recorded, transcribed verbatim, and analyzed by two researchers.

RESULTS

We collected approximately nine hours of audio data from 18 individuals in two focus groups (n = 12) and six individual interviews. Fourteen participants were female and the average age was 41 years (range 24 to 57 years). Expectations, decision-making, and supports were identified as central themes underlying the community pharmacy experiences of people with lived experience of mental illness and addictions. Eight subthemes were identified including: relationships with pharmacy staff; patient's role in the pharmacist-patient relationship; crisis and triage; privacy and confidentiality; time; stigma and judgment; medication-related and other services; and transparency.

CONCLUSIONS

People with lived experience of mental illness and addictions demonstrate a high regard and respect for pharmacist's knowledge and abilities but hold conservative expectations of pharmacy health services shaped by experience, observations, and assumptions. To some extent, expectation management occurs with the recognition of the demands on pharmacists and constraints inherent to community pharmacy practice. Relationships with pharmacy staff are critical to people with lived experience and influence their decision-making. Research in the area of pharmacists' roles in crises and triage, especially in the area of suicide assessment and mitigation, is needed urgently.

Suicide prevention in pharmaceutical education: Raising awareness with inspiring stories

Suicide rates are high in high-income countries like Canada and the United States, where 10 to 12 people per 100 000 commit suicide every year. In the United States, in 2011 there were 73.3 emergency room visits per 100 000 people for suicide attempts with prescription drugs. The latter were also involved in 13% of completed suicides between 1999 and 2013. In most cases, these drugs were distributed by members of our profession who could not predict this outcome. This led us to create an initiative to teach pharmacy students how to prevent suicide. A literature review and online search were performed to find documentation about pharmacists' commitment to the cause, but very little information exists. Thus, a training session was developed for third-year pharmacy students that includes basic statistics, arguments for involving pharmacists in suicide prevention, role-playing, tools to evaluate suicide risk, thoughtful verbatims of interview techniques, and case studies. It is delivered during the mental health theme of the psychiatry course. In 5 years, around 1150 students have participated in the course, of whom approximately 950 are now practicing pharmacists. This intervention may have prevented some suicides, although the impact is impossible to measure. The objective of this paper is to describe the creative process of designing a suicide prevention training session for pharmacy students, while inspiring a mental health sensitive readership to this noble cause. This article does not provide guidelines on how to replicate this initiative, nor does this article replace proper training on suicide prevention.