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We must develop a mental health support role

Why do we continue to think of our role solely in terms of medicines optimisation? Post-pandemic demand for mental health support means pharmacy has the ideal opportunity to offer solutions and make a difference, says Ade Williams

Let’s be honest: community pharmacy has never been short of reports on vision, leadership and “the future”.  

It is telling that I can play, with remarkable success, a game that I call ‘Match the Report©’.I can link the name of each report to a lead author, organisation or think tank. One thing they all have in common is the claim of a “new brighter dawn for pharmacy” – or something similar. This dawn has never actually broken, sadly. Could this be about to change?

The recently published Vision for Community Pharmacy by the Nuffield Trust and King’s Fund could not have been better timed. The findings sound similar to previous strategies but, as Bob Dylan says: “Times they are a-Changin’...”.

Community pharmacy, the report says:

  • Will play a key role in supporting people and communities to stay healthy and well, focusing on reducing health inequalities
  • Will have a much more clinically focused role, with members of the public consistently able to access care from community pharmacy teams for common conditions in a way that suits them and supports their health and wellbeing
  • Will support people to access and live well with their medicines and treatments, including new and advanced therapies, whenever they emerge
  • Has a skilled workforce providing high-quality services. It will continuously develop and improve how patients, the public and healthcare professionals are supported.

Add in the changes to the training of pharmacists – graduating with prescribing competence from 2026 – and the launch of the NHS England prescribing pathfinder programme, and I find myself wondering whether, taken together, all this could finally herald an exciting, new dawn for pharmacy.

I know I am allowing myself, dangerously so, to have unbridled hope and optimism that we can – and will – get it right. So let me explain what I think we need to do.

My plea to you

As change happens to us, pharmacy has to respond. As the profession transforms, let’s take a leaf from Columbus and Gide: “Crossing the ocean of opportunity by having the courage to lose sight of the shores that have defined us”. 

I come to make a case – a plea, if you like. Looking at the possible areas to be explored by the pathfinder sites, I am worried that the opportunity to ‘own’ an evidence-backed, much appreciated, maybe even uncontestable role in delivering population health and wellbeing may be missed as we continue to focus on medicines optimisation. After all, pharmacy and medicines go hand in hand. Don’t they?

Yet for community pharmacy, population health management and tackling health inequalities are equally core tenets of our practice.  

Take the area of mental health. The Royal College of General Practitioners’ policy paper on mental health published in 2017 affirms the evidence that people prefer to receive their mental healthcare in a primary care setting. The paper emphasises providing care as close to the patient’s home as possible, in a less stigmatising environment. It also underscores the importance of communication skills and relational continuity in the bio-psycho-social care model. 

“Now is the time to fully express how we can better support mental health and wellbeing in our communities”

Extra help needed

Post-pandemic demand for mental health support is outstripping supply and rising rapidly. Estimates suggest that 10 million people will need extra help for their mental health due to the pandemic – and 1.5 million will be children.

Making it easier for people to access help, providing excellent care, and enabling the safe and effective use of medication in this area is challenging. Community pharmacists potentially could play a significantly enhanced role here, which independent prescribing (or deprescribing) could further enable e.g. managing anticholinergic side-effects caused by antidepressants. 

Take the NICE guideline that when prescribing antidepressant medications, a first review should usually be within two weeks to check symptoms are improving and assess side-effects, or one week after starting an antidepressant medication if the new prescription is for a person aged 18 to 25 years (or if there is a particular concern for risk of suicide). Community pharmacists can absolutely lead on this. 

The opportunity for joined-up, shared care delivery, clinical mentoring and cross-professional working for patient benefit makes so much sense. It will remove barriers to access, further destigmatise mental health needs and enable more holistic care to be provided. It will also allow us to do what community pharmacy excels at – delivering health equity. 

Making a difference

I recognise that there are competence and confidence gaps in the community pharmacy workforce regarding mental health diagnostic assessment, communication and attitudes. However, evidence shows that mental health training programmes increase the skills of  pharmacy teams and give confidence to deliver mental healthcare in community pharmacy. 

This is another reason why mental health first aid training should be available for all community pharmacy teams in England. We need it to help care for our communities and ourselves. 

A paucity of ideas to explore this scope of practice is no sign of caution. In the face of such significant needs and the opportunity to make a difference, why can’t we come forward with our own solutions? 

Yes, there may be few models to adopt – but if we do the right thing, we must learn how to do it well. It is ambitions such as these that define our profession and transform lives, driving clinical innovation and best practice. That is how we address previously unmet needs. 

Making a difference is in the DNA of community pharmacy. With vision, opportunity and ambition, now is the time to express fully how we can better support mental health and wellbeing in our communities. Our new identity and the value ascribed to our expertise will shape our place in the consciousness of society. Is that not what all this is about?

• Ade Williams is lead pharmacist at Bedminster Pharmacy in Bristol

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