Barriers to access


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Community pharmacists are generally willing to deliver services to patients with mental illness, but there are issues with confidence and stigma, according to a new survey

US researchers recently carried out a survey on mental health service provision based on a national random sample of more than 3000 community pharmacists, of which they received 239 responses.

The survey results were published this week in the International Journal of Clinical Pharmacy.

Using a 101-item questionnaire, researchers from the School of Pharmacy at Duquesne University in Pennsylvania were interested to explore pharmacists’:

  • General understanding of mental illness;
  • Involvement in the delivery of clinical services for mental health;
  • Comfort and confidence in provision of these services;
  • Willingness to perform and interest in offering such services; and
  • Stigma, attitudes and beliefs towards individuals with mental illness.

In the context of mental health, top-rated items for willingness and interest were related to talking to patients about their medication and adverse effects.

Assessing patient knowledge regarding their medication and asking about adverse effects were also highest rated for comfort and confidence.

Pharmacists who provided medication therapy management services had significantly higher scores in levels of comfort, confidence, willingness and interest.

Increased delivery of pharmacy services was significantly associated with both willingness and interest to provide mental illness-specific services.

However in general, confidence in abilities (in dealing with mental illness in the pharmacy) was rated lowest.

And only 39% of respondents reported having adequate knowledge of medication therapy for mental illness.

Personal experience helps to ‘humanise’

Those who had personal experience with mental illness scored significantly higher across comfort, confidence, interest and willingness. This group comprised approximately half of respondents.

Meanwhile those who had no experience with mental illness demonstrated higher stigma and more negative attitudes.

“When individuals are able to ‘humanise’ mental illness through personal connections, it makes sense that they would develop less misunderstanding and fear, and exhibit less avoidance,” say the researchers.

“Available evidence suggests that access to community pharmacist services (counselling, education, monitoring and personalised care) is of high value for many individuals for mental illness, yet there are barriers to access.

“Pharmacists may harbour negative opinions about mental illness that disrupt delivery of care,” say the authors.

“Ultimately, patients who are stigmatised experience barriers to care, including an increased risk for treatment non-adherence, poor treatment outcomes and shorter lifespans.

“Pharmacists have a professional responsibility to recognise the unique needs of individuals with mental illness,” they say.

“In the community, this requires going beyond a product-centred service and working to establish a therapeutic alliance to meet the needs of patients with mental illness.

“There are calls for pharmacists to fulfil enhanced roles for patients with mental illness, including engagement in screening and risk assessments, wider provision of medication reviews and adherence interventions and participation in shared decision-making.

“These services are needed and desired by patients, but have to begin within the profession’s own motivation and commitment.”

In an effort to decrease the burden of stigma and break down barriers to care, there is a significant need for interventions to improve knowledge and attitudes related to mental illness among pharmacists, the authors conclude.

See the full article here

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