Concerns raised over pharmacy and mental health services

The Australian Psychological Society (APS) has voiced concerns about community pharmacists providing mental health services

Dr Louise Roufeil, Executive Manager Professional Practice at the APS, has submitted a letter in response to an article published by AJP that quoted George Tambassis, National President of the Pharmacy Guild of Australia.

The article, ‘Mental health focus welcomed’, discussed how the increased focus on the delivery of mental health services by the government has been welcomed by the Pharmacy Guild of Australia.

Dr Roufeil writes as follows:

I write to you with regard to concerning content published in the 27 June 2016 online issue of the Australian Journal of Pharmacy concerning the role of community pharmacists as the first point of call for individuals with mental health disorders. The APS is the largest professional organisation for psychology in Australia representing over 22,000 members and a significant portion of the membership practice as clinicians delivering evidence-based psychological services to consumers with mental health disorders.

It is important that pharmacists and the public alike have access to accurate information about mental health. In the article published on 27 June 2016, the Pharmacy Guild of Australia’s President, Mr. George Tambassis, is reported to have stated that:

“community pharmacists, as the most accessible of health professionals, were often the first health professional a distressed person with mental health issues might see.

“Community pharmacists may often be available when a doctor is not,”

“Community pharmacists can also undertake a mental health first aid course to further equip them in the initial counselling of mental health patients.”

“In addition, community pharmacists know their regular patients and can quickly spot and identify when one of them is experiencing a mental health issue.”

“They can also quickly refer the patient for further counselling or treatment when necessary.”

These claims are misleading in a number of ways:

• Mental health first aid courses are designed to provide members of the general community with a foundational level of understanding of mental illness. The purpose of mental health first aid courses is to prevent harm, preserve life, and reduce risk factors. Mental health first aid training would not adequately equip pharmacists to provide the services referred to in these claims, that is: “the initial counselling of mental health patients”, the capacity to “quickly spot and identify” when someone is experiencing a mental health issue, and the ability “to refer the patient for further counselling or treatment psychological therapy”.

• Community pharmacists cannot refer individuals for psychological treatment under the Medicare Benefits Schedule or through Primary Health Networks; referrals can only be made by general practitioners, and in some cases, paediatricians and psychiatrists.

The claims are also potentially harmful:

• Community pharmacists are not trained to raise topics such as deterioration in mental health status with a patient. If this communication is handled poorly, there is the potential that it will inadvertently put the patient, pharmacist and other members of the public in the pharmacy at risk.

• Community pharmacists are not trained to accurately assess the level and imminence of the risk of suicide (or risk of harm to others) nor how to develop and implement an appropriate risk management plan. Mental health first aid training will not provide pharmacists with these skills.

• The Code of Conduct for Pharmacists does not address issues relevant to the delivery of primary mental health services.

• Not all pharmacies are equipped with the necessary facilities to provide a confidential mental health service such as a private space for dialogue about personal mental health information.

• Patients may inadvertently believe that the pharmacist can assist them and not seek appropriate treatment by a qualified mental health professional.

Despite the widespread availability of community pharmacists, there is robust evidence that the Australian community sees general practitioners as the first point of call for professional help for mental health problems (Reavley & Jorm, 2011).

Whilst the APS appreciates that pharmacists are exposed to community interactions and see people present in a variety of manners, this does not equip them to counsel, refer or assess risk. Moreover, mental health first aid training will be insufficient to provide the necessary skills and ethical framework to safely deliver these services.

The APS is concerned about the potential for this type of approach not only to increase the risk for vulnerable members of the community but also to expose community pharmacists and their businesses to very high levels of risk.

Dr Louise Roufeil PhD FAPS MCHP
Executive Manager Professional Practice,
Australian Psychological Society

The Guild has been notified about the letter and is in contact with the APS for further discussions.

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  1. Amy

    That’s all very well to say that we are ill-equipped and should not provide mental health services. But whether we want them to or not, patients come to us with deteriorating mental health and I would like to know the best course of action (I dont feel that ignoring their deterioration is appropriate at all!). If current Mental Health first aid is inadequate please suggest an alternative!

    • Andrew Griffin

      Exactly – it would be great to see some collaboration between PSA and APS to develop some kind of course that would give pharmacists a robust, evidence-based framework for dealing with patients with mental health issues.
      Actually, why not incorporate this into university learning? The reality is that a sizeable proportion of patients that pharmacists see every day will be collecting medication for one mental health problem or another.

      • Diane

        I agree.
        A few days ago, I was able to encourage and reassure a patient to see a psychologist as she clearly needs guidance. She was hesitant to see one as she was told by family that seeing one is a sign of weakness.
        I myself have consulted with a psychologist and what they do is beyond the scope of a pharmacist. But we are in a position to help a patient get the help they need and collaborate with other health professionals.

  2. Hmmm

    I thing is pharmacist deal with mentally ill patients every day. Wether this psychologists likes it or not people will walk in and often drop their life’s problems at your feet. We know who hasn’t been taking their medication and who is showing signs of psychosis and often help them get in with a doctor or put their medication fears to rest.
    I don’t think anyone wants to be a psychologist and pharmacists are no more untrained in this area then a GP. if anything we hear more of patients stories and listen to the often when no one else has. The point is we are often the first port of call due to easy access and being free in a way psychologists and GP’s are not. What does he suggest we do ignore mentally ill patients? Don’t ask if they are ok when they clearly are not? Ignore the suicial patient? Pharmacists are not treating these patients as we can’t but offering kind support, helping them adjust to medication and referring to the GP if we have concerns.

  3. Jarrod McMaugh

    I think Dr Roufeil has gone beyond what Mr Tambassis was discussing – his comments are regarding the placement of pharmacists in the timeline of patient-health system utilisation….. ie we see people early and often, and can help identify when a patient is experiencing a mental health issue – from crisis through to dissatisfaction with current treatment.

    On the other hand, it seems that Dr Roufeil is suggesting that the intent of pharmacists is to create a new treatment paradigm, wherein pharmacists step in to the role already performed by the GP (in coordinating a patients referral path) and the psychologist (in providing structured counselling).

    Pharmacists are already doing what Mr Tambassis describes; his comments are highlighting what we do already, and how a focus by government in this area of health can provide some structure and funding to these roles we already undertake. Pharmacy can’t quarantine itself from dealing with mental health patients any more than psychologists can quarantine themselves from having discussions with a patient about chronic conditions that aren’t directly related to mental health.

    I think these comments from Dr Roufeil could have been much more productive. There isn’t a threat here, and working collaboratively with psychologists would be a great step forward for patients.

    With regards to the Mental Health First Aid course – this course is specifically designed for people who’s exposure to mental health crises are not clinical. While pharmacists operate within the mental health field when discussing a patient’s treatment, we may not be exposed to an acute presentation. The course is an excellent start for anyone who is unsure of how they would proceed when they have a patient in acute crisis. Further to this, courses such as SafeTalk – – are a great way to build on this further.

  4. Fiona Blee, MHFA Australia

    Mental Health First Aid (MHFA) courses do not teach participants to provide ‘initial counselling’ as stated by Mr Tambassis. However, MHFA courses do teach participants how to recognise the signs and symptoms of mental health problems and mental health crises, and give appropriate information and support until the person can be referred to an appropriate professional, if needed.

    MHFA courses have been extensively evaluated and have been shown to improve participant knowledge of mental illnesses and their treatments, knowledge of appropriate first aid strategies, and confidence in providing mental health first aid to individuals with mental illness. Research shows that these benefits are sustained over time. Some studies have also shown improved mental health in those who attend the training, decreases in stigmatising attitudes and increases in the amount and type of support provided to others:

    We agree with Mr Tambassis that pharmacists are appropriate frontline workers to be trained in MHFA and that this training is likely to contribute in their ability to identify individuals with mental health problems through their interactions with community members.

    A key component of MHFA is assisting in referral to appropriate mental health professionals such as GP’s as evidenced in the MHFA Action Plan (Approach, assess and assist with any crisis; Listen non-judgementally; Give support and information; Encourage appropriate professional help; Encourage other supports):

    Dr Roufeil mentions that MHFAiders are not qualified to intervene in a situation where a community member is considering suicide. On the contrary, the MHFA course does teach appropriate skills for a member of public to give initial help to a suicidal person. This information is based on consensus of expert opinions of a panel of mental health consumers and professionals from Australia, New Zealand, the UK, the USA and Canada about how to help someone who may be at risk of suicide:

    MHFA courses have been taken up by numerous professional groups around Australia including police, teachers, occupational therapists, speech pathologists and physiotherapists. A controlled trial with 60 pharmacy students found that MHFA training reduced students’ mental health stigma, improved recognition of mental illness and improved confidence in providing services to consumers with a mental illness in the pharmacy setting (O’Reilly, 2011).

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