A role for pharmacists in suicide prevention?

The NHS Five Year Forward View identified reducing suicide rates as one of its primary goals, and yet 6507 people died by suicide in 2018 in the UK alone (Office for National Statistics, 2018).

One study reported that over 80 per cent of those who die by suicide visited health care professionals in the year prior to death (Ahmedani et al., 2014). Despite this opportunity to identify clients at risk, primary care providers (PCPs) rarely discuss suicidal ideation with their clients (O'Connor et al., 2013), as the time available for suicide risk assessments is limited. Are others in the community capable of identifying individuals at risk of suicide?

Pharmacists have regular contact with clients who may be suicidal. In recent years, the role of pharmacists has changed. They increasingly offer both advice and consultations to the public. One study reported that pharmacists see mental health service users on average 31 times more a year than their PCPs (Moose & Branham, 2014). Many pharmacists become familiar with regular clients and, as a result, may be better placed to identify deteriorations in mental state than PCPs.

The primary barrier to pharmacists intervening is lack of confidence (Watkins et al., 2017), which stems from the belief that they do not possess the appropriate skills or knowledge to assess risk of suicide (Gillette et al., 2019). Pharmacists could be trained to identify those at risk, provide support for suicidal individuals and make referrals to appropriate primary and secondary care services. Suicide prevention and mental health first aid training could be incorporated into pharmacy degrees.

Moreover, it is essential that pharmacists become more involved in the care of mental health service users. Systems could be developed to inform pharmacists of clients who are at high risk of suicide, such as those who have previously attempted suicide (World Health Organization, 2014). Pharmacists could remain particularly vigilant over such individuals and prompt appropriate discussions around the topic by suitably trained professionals.

At the time of writing, the UK lacks sufficient data regarding the influence of Covid-19 on suicide rates. Working in a community mental health team, I have seen a dramatic rise in mental health concerns during the outbreak. Pharmacies remain open, so pharmacists would be well placed to identify and help those at risk of suicide. Moreover, the social and economic consequences of the coronavirus will outlast the pandemic, undoubtedly resulting in additional negative ramifications on mental health. Therefore, providing pharmacists with suicide prevention training is of unequivocal importance in coping with the fallout of Covid-19.

Health care providers are under increasing pressure and it is becoming ever more important that we utilise community-based services in supporting those with mental health issues. Training pharmacists would help towards the goals of the NHS Five Year Forward View.

Liam Myles
Assistant Psychologist
Surrey and Borders Partnership
NHS Foundation Trust

References

Ahmedani, B.K., Simon, G.E., Stewart, C. et al. (2014). Health care contacts in the year before suicide death. Journal of general internal medicine, 29(6),870-877.

Gillette, C., Mospan, C.M. & Benfield, M. (2019). North Carolina community pharmacists' attitudes about suicide and willingness to conduct suicidal ideation assessment: A cross-sectional survey study. Research in Social and Administrative Pharmacy, 16(5), 727-731.

Moose, J. & Branham, A. (2014, 21 August). Pharmacists as influencers of patient adherence. Pharmacy Times.

O'Connor, E., Gaynes, B., Burda, B.U. et al. (2013). Screening for suicide risk in primary care: A systematic evidence review for the U.S. preventive services task force. Agency for Healthcare Research and Quality.

Office for National Statistics. (2018). Suicides in the UK: 2018 registrations. Registered deaths in the UK from suicide analysed by sex, age, area of usual residence of the deceased and suicide method.

Watkins, A., McKee, J., Hughes, C. et al. (2017). Community pharmacists' attitudes toward providing care and services to patients with severe and persistent mental illness. Journal of the American Pharmacists Association, 57(3), 217-224.

World Health Organization. (2014). Preventing suicide: A global imperative.