The community pharmacy role in suicide prevention
The inclusion of antidepressants in the New Medicine Service for community pharmacists provides a good opportunity for pharmacist to provide extra support for patients at a critical time, says Dr Hayley Gorton, senior lecturer in pharmacy practice at the University of Huddersfield and suicide prevention researcher.
Pharmacists and pharmacy teams that want to find out more about contributing to suicide prevention work should consider using the resources available from Mind and the Samaritans, the Zero Suicide Alliance and Hub of Hope. A suicide awareness video is also available from the Centre for Pharmacy Postgraduate Education in England (CPPE). No matter how much preparation and training is done in advance it will probably “take you by surprise if you find yourself in that situation having to talk to someone [about suicide] so it’s also important to think about how you would look after yourself afterwards”, says Dr Gorton. She suggests having a debriefing plan e.g. a trusted colleague with whom it could be discussed.
Antidepressants will be included in the New Medicine Service (NMS) from April 2023 onwards and this may helpful in this context. Dr Gorton says, “I’m really pleased to see antidepressants included in in the New Medicine Service. Until now there haven’t been any medicines for mental health conditions included in the service and I know the pharmacy world seems to be quite pleased about this. We will therefore have people that we know have a diagnosis of anxiety or depression amongst other things that we have the opportunity to have these in-depth conversations with”. Having a pre-existing mental health problem increases a person’s risk of suicide, she notes.
The AMPLIPHY study1 was described as ‘NMS plus’ by many of the pharmacists who were involved, although it was not designed as such. In fact, it was concerned with changes of dose, changes of antidepressant or new antidepressant treatment. However, it provided important information, such as the value of using Hub of Hope as a resource, that will be useful as the new NMS service is implemented.
Dr Gorton sounds a note of caution about the timing of the NMS in relation to antidepressant treatment: “One of the difficulties in mental health epidemiology and looking at medicines and risk is that, actually, by definition, having been prescribed [a new antidepressant], someone’s condition has probably got worse so these people are in a position where they actually might need some extra support. Antidepressants can take up to six weeks to work – I’d like to see the New Medicine Service extended to enable that coverage. You know, actually, if it stays at the four-week mark, what happens to those people that perhaps are not getting the benefit from the medicines but are about to get the benefit from the medicines? and if we follow them up a little bit more intensively would that be helpful?”
Dr Gorton is not the only pharmacist with an interest in suicide prevention – there is a small network of pharmacists around the world who share her interest and it is open to others who wish to join. She is a co-chair of the International Association of Suicide Prevention special interest group on suicide prevention in primary care. As the recipient of a Churchill Fellowship, she was able to visit a number of colleagues including Andrew Murphy and David Gardner in Canada, Claire O’Reilly in Australia and also some colleagues in the USA where she was hosted by Professor Jill Levine. “We’re all linked now and actually what you can see from the research is that we are coming up with very similar things. But all the research has been done in high income countries yet over three quarters of suicides in the world are in low- and middle-income countries (LMICs) so actually, that’s a really important gap”, she says. One of her PhD students, Somto Chike-Obuekwe, is now starting to look at this in the Nigerian context, she adds.
- Gorton HC, Riste L, Littlewood D, Pickering G, Armitage CJ, Ashcroft DM. Advancing Mental heaLth Provision In PHarmacY (AMPLIPHY): A feasibility study. Res Social Adm Pharm. 2022 Aug;18(8):3414-3424. doi: 10.1016/j.sapharm.2021.11.001. Epub 2021 Nov 9. PMID: 34774424.
Dr Hayley Gorton MPharm, PhD, PGDip (ClinPharm), MRPharmS, FHEA, CF is a senior lecturer in pharmacy practice at the University of Huddersfield. She is also a co-chair of the Association for International Association of Suicide Prevention special interest group on suicide prevention in primary care. At the recent FIP Congress (Seville, 2022) Dr Gorton gave a presentation entitled, Suicide prevention: Are pharmacy teams an overlooked and indispensable asset?