Should Pharmacists Conduct Mental Health Evaluations?

According to the most recent CDC data, more than 20% of American adults receive counseling or treatment from a mental health professional.¹ With a national emergency in mental health in children formally declared in 2021² and the White House recently declaring that “our nation is facing a mental health crisis among people of all ages,”³ it is no wonder that mental health professionals are overburdened, often not having time to take on new patients—let alone conduct initial screenings.

Compounding the issue is the fact that the United States does not have enough mental health providers. According to The Commonwealth Fund, nearly half of all Americans will have a behavioral health issue in their lifetime and fewer than half of people with a current mental health illness are able to receive timely care.⁴ In light of these statistics, some pharmaceutical professionals are suggesting that pharmacists step in to offer screenings of patients with mental health concerns.

Even before the national emergency in mental health was declared, pharmacists were discussing this in literature. In a 2021 article in Pharmacy Practice, the authors noted, “Pharmacists are accessible and trusted health care professionals who have an important role in supporting people living with mental illness.”⁵

However, not everyone agrees about the extent that pharmacists, who are also overtaxed, should become involved. “Primary care [physicians] have real difficulty in having the training and then the time to follow up [on] these screening tests,” Michael S. Jellinek, MD, professor of psychiatry and pediatrics at Harvard Medical School in Boston, Massachusetts, said. “It is hard to imagine that pharmacists, with little training, little time, and often no office to offer privacy, will manage the interviews for positive [screening results]. How would records be kept? How would the primary care [physicians] get the information? How would they get consent for minors? Focusing on the medication [adverse] effects [and] allergies and engaging the patient so they keep taking the medication are a heavy enough lift.”

However, many in this community believe mental health screenings can be successfully conducted by pharmacists. As far back as 2014, in an article published in the International Journal of Environmental Research and Public Health,⁶ the authors wrote, “Screening and risk assessment services in community pharmacy are common and routinely performed for a range of chronic conditions such as diabetes, hypertension, or respiratory disorders, yet screening is not commonly performed for depression in the pharmacy setting. A number of recent studies have highlighted the capability of community pharmacists to…refer people at risk of depression to appropriate health services and have demonstrated that this is a feasible…service for pharmacists to be involved in.”

So what kind of screenings can and should pharmacists be offering? Pharmacists in some states are already using the Patient Health Questionnaire (PHQ), a widely known mental health assessment tool. A study of pharmacists using the PHQ in Ohio at 32 large chain pharmacies reviewed the feasibility of implementing depression screenings in community pharmacies and found them effective in helping to provide diagnoses for patients with depression and those not having adequate symptom control.⁷ “We found the PHQ-2 [2 questions from the PHQ that refer to experiencing depression over the prior 2 weeks] was a good initial brief screening tool to identify those at risk, and based on the outcome of the initial result, those [with] positive screening [results] or at high risk would, if needed, complete the PHQ-9 [the depression module of the PHQ], as we found that tool to be the most accurate yet easy to use,” Peter Miller, PhD, Diploma of Hospital Pharmacy, of the University of Newcastle in New South Wales, Australia, added. Miller was the lead investigator of a study to evaluate evidence for the feasibility and impact of community pharmacists screening adults for depression published in the International Journal of Pharmacy Practice. ⁸

Though wide-scale studies have yet to be conducted to determine the viability of a nationwide pharmacy mental health screening program, community pharmacists can still improve their approach to mental health care within their current practice.

READ MORE: Mental and Behavioral Health Resource Center

References

1. Terlizzi EP, Norris T. Mental health treatment among adults: United States, 2020. CDC. October 2021. Accessed March 5, 2024. https://www.cdc.gov/nchs/products/databriefs/db419.htm

2. AAP-AACAP-CHA declaration of a national emergency in child and adolescent mental health. American Academy of Pediatrics. Updated October 19, 2021. Accessed March 5, 2024. https://www.aap.org/en/advocacy/child-and-adolescent-healthy-mental-development/aap-aacap-cha-declaration-of-a-national-emergency-in-child-and-adolescent-mental-health/

3. Prabhakar A, Rice SE. White House Report on Mental Health Research Priorities. The White House. February 7, 2023. Accessed March 5, 2024. https://www.whitehouse.gov/ostp/news-updates/2023/02/07/white-house-report-on-mental-health-research-priorities/

4. Understanding the U.S. behavioral health workforce shortage. The Commonwealth Fund. May 18, 2023. Accessed March 5, 2024. https://www.commonwealthfund.org/publications/explainer/2023/may/understanding-us-behavioral-health-workforce-shortage

5. Rubio- Valera M, Chen TF, O’Reilly CL. New roles for pharmacists in community mental health care: a narrative review. Int J Environ Res Public Health. 2014;11(10):10967-10990. doi:10.3390/ijerph111010967

6. Rosser S, Frede S, Conrad WF, Heaton PC. Development, implementation, and evaluation of a pharmacist-conducted screening program for depression. J Am Pharm Assoc (2003). 2013;53(1):22-29. doi:10.1331/JAPhA.2013.11176

7. Miller P, Newby D, Walkom E, Schneider J, Li SC. Depression screening in adults by pharmacists in the community: a systemic review. Int J Pharm Pract. 2020;28(5):428-440. doi:10.1111/ijpp.12661