Community pharmacists and the assessment and management of suicide risk

Abstract

The recent canadian federal framework for suicide Prevention Act (s.c. 2012, c.30) identifies suicide as a national public health issue that requires federal, provincial, territorial and nongovernmental organization cooperation and action.1,2 The framework sets forth a process intended to fulfill the requirements of the act. This includes numerous directives, of which at least 3 fit well with the work of community pharmacists 1,2 :• Disseminating information about suicide and its prevention • Defining best practices for the prevention of suicide • Promoting the use of research and evidence-based practices for the prevention of suicide However, the potential contribution of community pharmacists in suicide prevention strategies is not well recognized. Neither the Mental Health Commission of Canada nor the Canadian Society for Suicide Prevention identify a role for community pharmacists in their recent documents pertaining to suicide prevention. 3,4 This likely reflects the overall absence of pharmacy-focused research in this area rather than the absence of an active opportunity for community pharmacists in identifying and responding to people at risk of suicide. 5,6 Through our combined years of research focused on mental illness and the community pharmacist, our own clinical experience and tacit knowledge and our numerous committee and panel experiences, we know that community pharmacists are regularly directly involved in the care of people at risk of suicide. We are also aware that suicide prevention in the community pharmacy setting has received little professional attention. Suicide is a major public health problem in Canada, and our national mental health strategy identifies suicide prevention in its first of 6 strategic directions. 7 The rate of suicide is 3 times higher in men than in women, rising rapidly during adolescence and peaking in both sexes during midlife (see Figure 1). 8,9 Self-poisoning is the leading cause of death by suicide in women and is second to hanging in men. In people 40 to 59 years of age, suicide rates by poisoning and hanging are similar. Most sobering is that suicide accounts for 20% to 25% of deaths in adolescence and early adulthood, second only to motor vehicle accidents. 10 Physical conditions that compromise quality of life (e.g., heart failure, chronic obstructive pulmonary disease, severe pain, etc.) independently elevate risk of medication overdose deaths in older adults.11 In younger people, a major predictor of suicide, in addition to the presence of mental disorders, is self-injurious behaviours (i.e., nonfatal self-poisoning or self-injury irrespective of suicidal intent).12 The greatest risk of death by suicide occurs in the period following self-injurious behaviours, including overdoses. 13Knowledge of suicide patterns and risk factors is important for community pharmacists in their daily practice, especially when considering that self-poisoning with medication is a leading cause of suicide-related hospitalizations and death. 10,14 A recent coroner's study of overd...

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

“…Finally, an important subtheme in our findings was the notion of crises and triage by pharmacists, especially around suicide, including by self-poisoning, which was discussed by some of our participants. The research to date on the topic of pharmacist assessment and mitigation of suicide is practically non-existent and urgently requires attention [ 77 ], especially given trends regarding suicide attempts and suicides, including the use of medications as a means for suicide [ 77 – 87 ]. Recent study findings by Finkelstein et al [ 87 ] highlight important lessons for community pharmacists who may be involved in the provision of medications that may be used in some self-poisonings (both prescription and non-prescription medications).…”

“…Others whom may have had a psychiatric illness would have visited a pharmacy to obtain a medication for a concurrent medical disorder (e.g., respiratory or cardiac disease, cancer, etc.). Thus, it is highly probable that pharmacists encounter patients at risk of suicide by self-poisoning and therefore a more comprehensive approach is needed for education, training, and research related to pharmacists’ roles in suicide risk assessment and mitigation [ 77 ].…”

Evaluation of participant reluctance, confidence, and self-reported behaviors since being trained in a pharmacy Mental Health First Aid initiative

“…[4,[8][9][10][11] Persons experiencing mental health crises, including those with warning signs of suicide, can present to pharmacies, clinic appointments, or other pharmacy practice settings during routine interactions such as when people procure medications, seek advice over the telephone, or engage with other pharmacy services. [8,[10][11][12][13][14] Studies in pharmacy, however, cite a variety of barriers to intervening [8,10,15,16], including a lack of confidence by the pharmacist [14,17] and a need for additional training. [13,17] Pharmacists, especially those in the community-based setting, could play a key role in identifying people in mental health crises and refer them to appropriate professional help.…”

Student Pharmacists’ Attitudes Toward Suicide and the Perceived Role of Community Pharmacists in Suicidal Ideation Assessment

“…19 Community pharmacists may encounter patients experiencing mental health needs, and personal attitudes could significantly impact patient care and access. 11,20,21 The purpose of this research was to investigate firstyear Doctor of Pharmacy (PharmD) students' attitudes toward suicide and their perception of the community pharmacist's role in assessing for suicidal ideation, and to determine whether student pharmacists' previous pharmacy work experience is associated with these attitudes and perceptions.…”