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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