Mental Health First Aid Training for Student Pharmacists

by Taylor Williams, Doctor of Pharmacy Candidate, University of Mississippi School of Pharmacy 

Summary and Analysis of:  El-Den S, Chen TF, Moles RJ, O’Reilly C. Assessing Mental Health First Aid Skills Using Simulated Patients. Am J Pharm Educ 2018; 82 (2): Article 622.

One in six people in the United States uses psychotropic medications and psychotropic medications representing 13% of the top 300 most frequently prescribed medications in the United States.¹  In a 2012 survey designed to characterize the relationship between individuals with mental health conditions and community pharmacists, approximately 80% of individuals and family caregivers indicated they received their medications for mental health conditions from a community pharmacy.²  Given that community pharmacists see patients with psychiatric illnesses every day, it is imperative that student pharmacists know how to skillfully interact with these patients. Many prescriptions have refills for up to three months, so these patients may see their pharmacist more than any other healthcare provider. This is why it is essential that student pharmacists have adequate training on how to interact with people who suffer from mental illness.

However, a survey of pharmacy schools reported that only 9.5% of the didactic course content was dedicated to psychiatric topics.³  Furthermore, a survey of North Carolina pharmacists, concluded that despite the volume of prescriptions with mental health-related medications every day, a significant portion of licensed pharmacists indicated that the emphasis on mental health in their training was inadequate.⁴  These results suggest that pharmacy programs are not providing student pharmacists with enough training to become mental health first aid responders. So how are we preparing our future pharmacists to serve patients with mental illness? While being knowledgeable about psychiatric medications is essential, many student pharmacists have not been trained to manage a mental health crisis.  The methods and criteria used to ensure students have mastered these skills before graduating do not appear to be adequate.

An educational program implemented at The University of Sydney explored different teaching strategies to train student pharmacists to become mental health first aid (MHFA) responders.⁵ One hundred and sixty-three fourth-year bachelors of pharmacy students in their final semester before earning their degree completed MFHA training, with 88% of the students completing the post-training confidence level evaluations following the simulations.⁵ Postnatal depression (PND) and suicide vignettes were randomly assigned to 36 students and their simulation performances and MHFA training were compared to their self-evaluations.⁵ The study compared the teacher feedback with post-training self-evaluations. The trainers developed an assessment rubric based on the Mental Health First Aid Action Plan. This rubric was completed by the simulated patients to assess students’ MHFA skills during the roleplays.  The encounters were audio recorded in order to facilitate performance feedback and to give students an opportunity to self-assess their own performance.⁵ The study authors concluded that after receiving MHFA training most students overestimated or underestimated their ability to appropriately respond in a mental health first aid crisis. While these results show there is much work to be done, it also gives insight into how we can better educate students.

 

Learning is an active process. We learn by doing. 

Only knowledge that is used sticks in your mind. 

– Duke Corregie

 

The key to this educational program and others is the realization that “knowing” is different than “knowing how”.⁵  In other words, while students may know what to do in a mental health crisis, they may not know how to respond when confronted with a patient in crisis. Indeed, over 95% of pharmacy students who participated in this study agreed or strongly agreed that they were confident after participating in the suicide vignette. Moreover, only 50% of students took the appropriate actions, which involved both referring the patient to an appropriate health care professional and not leaving the simulated patient alone.⁵  This suggests the best way to assess pharmacy students is to not depend solely on written or verbal evaluations of their knowledge, but we must evaluate their actions when placed in real-life scenarios. This study had notable limitations, one being that the sample was only from one university.  Further, there were only two types of mental health crisis scenarios evaluated. Thus, the results might not be generalizable to students attending other schools or when addressing other mental health problems. However, despite these limitations, the study hypothesized the reason the student’s scores did not align with their self-assessment may be due students felt uncomfortable providing help to suicidal persons. None-the-less, MHFA training with the addition of simulation proved to be an effective teaching method.

There are many benefits to role-playing/simulation training. The Northern Illinois University Center of Teaching and Learning explained some advantages of using role-play.⁶ Some of the benefits include motivating and engaging students, enhancing current teaching strategies, providing real-world scenarios to help students learn, and providing opportunities for critical observations of peers.⁶  Simulation training gives students the opportunity to receive positive and constructive feedback from their teachers.

In a recent study that surveyed mentally ill patients, they found that 75% of respondents reported they seldom or never receive assistance from their pharmacist regarding their medication when they pick up their prescription at a community pharmacy, and 40% of participants felt that they did not have a strong relationship with their pharmacist.¹  As future pharmacists, we should work to eliminate barriers to care. I feel the best way to do so is to actively engage students through role-playing/ simulation scenarios paired with training while in school similar to the MHFA developed by the University of Sydney.

This study reinforces the effectiveness of using simulation training as a teaching tool. Simulation training allows pharmacy students to practice in a setting similar to where they will be practicing. During simulation training, students are given feedback on their performance and have an opportunity to correct problems. Becoming a mental health first responder takes both knowledge and experience. By implementing simulation training into the core curriculum in pharmacy school, students will be better prepared for their future roles.

References

 

1. Moore CH, Powell BD , and Kyle JA. The Role of the Community Pharmacist in Mental Healt U.S. Pharmacist 2018; 43 (11): 13-20. Accessed October 14,2020 
2. Carley CF and Stimmel GL. Characterizing the Relationships Between Individuals with Mental Health Conditions and Community Pharmacy . CPNP Foundation, December 2012. Accessed October 14, 2020
3. Cates ME, Monk-Tutor MR, and Drummond SO. Mental Health and Psychiatric Pharmacy Instructions in US Colleges and Schools of Pharmacy Am J Pharm Educ 2007; 71 (1): Article 04 Accessed November 1,2020
4. Goodman CS, Smith TJ. and LaMotte JM. A Survey of Pharmacists’ Perceptions of The Adequacy of Their Training For Addressing Mental Health-Related Medication Issues. The Mental Health Clinician 2017; 7(2): 69-73. Accessed November 1,2020
5. El-Den S, Chen TF, Moles RJ, and O’Reilly C. Assessing Mental Health First Aid Skills Using Simulated Patients Am J Pharm Educ 2018; 82 (2): Article 6222. Accessed October 14,2020
6. Role Playing. Northern Illinois University Center for Innovative Teaching and earning. 2012. Accessed October 14,2020