Current and potential contributions of community pharmacy teams to self-harm and suicide prevention: A qualitative interview study

Abstract

BackgroundSuicide prevention is a global priority. Despite the focus on primary care in suicide prevention, little is known about the contributory role of community pharmacists and nothing about the role of the wider community pharmacy team in this area. We aimed to explore the current and potential role of community pharmacy teams in self-harm and suicide prevention.MethodsWe conducted one-to-one semi-structured qualitative interviews with community pharmacy staff (pharmacists, pre-registration pharmacists, pharmacy technicians, dispensing/pharmacy assistants, delivery drivers) in the North West of England, UK. We identified themes from the interview transcripts through an iterative process of inductive thematic analysis.ResultsWe conducted twenty-five interviews with community pharmacy staff. Many described examples of helping those who were contemplating suicide or self-harm. No participants had received suicide prevention training. We identified six themes. The first two themes (i) Relationship with Patient and (ii) Pharmacy environment were seen as facilitators, which, if supported by (iii) Training, could underpin the final three themes: (iv) Opportunities for contact, (v) Facilitated referral pathway and (v) Restricting access to means. The distinct lack of training should be overcome with evidence-informed training. Referral pathways should be clear and enable direct and accessible referral by community pharmacy teams. There are opportunities for existing pharmacy services and schemes to be adapted to maximise suicide and self-harm prevention activities. Pharmacy teams did not identify themselves to have a clear role in restricting access to medication.ConclusionsPharmacy teams already support patients in relation to self-harm and suicide, often relying on their personal experience in the absence of formal training. With the implementation of evidence-informed training and clear referral pathways, this could be done in a more effectively.

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

“…Pharmacies should continue to work to better understand the people that use their pharmacy and establish relationships as doing so can decrease stigma and increase help-seeking. [10,15,35]. While having a prior relationship has been reported by pharmacists as a facilitator for mental health crisis intervention [15] it should not be a requirement as MHFA is intended for any person, regardless of background, to help someone without needing a prior relationship.…”

“…[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.…”

“…[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. [10,11,14,18,19] Research suggests Mental Health First Aid (MHFA) can increase trainee knowledge, decrease reluctance, decrease stigma, and improve confidence related to intervening with persons experiencing mental health crises, including suicidal ideation. [20,21] Studies also suggest that MHFA training increases behaviors like identifying people in mental health crises and making referrals in the months and years following the initial MHFA training.…”

Healthcare professionals’ implementation of national guidelines with patients who self-harm

“…While we aimed to recruit a representative sample, the generalisability of the responses is limited since professionals from minority ethnic backgrounds, under 35, and male were under-represented. Further, some professions with vital roles in self-harm management including pharmacists ( Gorton et al, 2019 ) were absorbed into the uncategorised category, which obfuscated data unique to these professionals. In future, researchers could stratify their samples to represent the breadth of professionals that are involved in self-harm prevention.…”

Suicide Prevention in Primary Care

“…This highlights the importance of making each healthcare contact count in primary care and aiming for enhanced mental health care of all patients (John et al, 2020;Pearson et al, 2009). Community pharmacy staff recognize they are an underused yet key component of a system response to suicide prevention (Gorton et al, 2021;Gorton et al, 2019). The value of this has been recognized in England through the incentivization of community pharmacy staff to complete suicide prevention training before February 2021 (Pharmaceutical Services Negotiating Committee, n.d.): We are not aware of similar schemes in other countries.…”