MENTAL HEALTH AWARENESS IN THE PHARMACY SETTING
Pamela Sardo, PharmD, B.S.
Pamela Sardo, PharmD, B.S., is a licensed pharmacist and Freelance Medical Writer at Sardo Solutions in Texas.
Stress, burnout, and mental health concerns are underappreciated issues that can affect workers in all fields, including pharmacists and other healthcare staff. These issues might be attributed to numerous factors, such as genetics, environment, or employment factors, which include time constraints and performance metrics. Pharmacists spend so much time helping patients, practitioners, administrators, loved ones, and others, it is critical to commit to caring for oneself. There is a risk of negative health outcomes with suboptimal mental health status, so a personalized approach to resolving individual mental health issues is important. Addressing potential causes and solutions with resources contributes to empowerment and opportunities to improve self- care and patient care.
RxCe.com LLC is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education.
Universal Activity Number (UAN): The ACPE Universal Activity Number assigned to this activity is
Pharmacy Technician 0669-0000-22-063-H99-T
Credits: 1 hour of continuing education credit
Type of Activity: Knowledge
Media: Internet Fee Information: $4.99
Estimated time to complete activity: 1 hour, including Course Test and course evaluation
Release Date: November 11, 2022 Expiration Date: November 11, 2025
Target Audience: This educational activity is for pharmacists.
How to Earn Credit: From November 11, 2022, through November 11, 2025, participants must:
Read the “learning objectives” and “author and planning team disclosures;”
Study the section entitled “educational activity;” and
Complete the Course Test and Evaluation form. The Course Test will be graded automatically. Following successful completion of the Course Test with a score of 70% or higher, a statement of participation will be made available immediately. (No partial credit will be given.)
Learning Objectives: Upon completion of this educational activity, participants should be able to:
Identify a pharmacist’s role in mental health awareness
Describe and distinguish clinical signs and symptoms of pharmacy staff stress and burnout
Demonstrate risk reduction strategies to address pharmacy staff stress
Use this information to answer questions about mental health awareness
The following individuals were involved in the development of this activity: Pamela Sardo, PharmD, B.S., and Susan DePasquale, MSN, PMHNP-BC. There are no financial relationships relevant to this activity to report or disclose by any of the individuals involved in the development of this activity.
ⓒ RxCe.com LLC 2022: All rights reserved. No reproduction of all or part of any content herein is allowed without the prior, written permission of RxCe.com LLC.
The role and responsibilities of pharmacists have been steadily expanding. With this greater role and responsibilities, stress, burnout, anxiety, and other issues have grown in significance. These negative mental conditions and feelings can impact the health of the pharmacist and the care patients receive. In order to combat stress, burnout, and anxiety, pharmacists need to know the risk factors for them and improve their mental health through awareness and reasonable interventions, especially self-care.
The Expanded Role of the Pharmacist in Healthcare
The role and responsibilities of pharmacists have changed over the years. During the mid-1900s, the treatment of patients living with mental illness shifted from institutionalized, inpatient care to outpatient care.1 In the 1970s, pharmacists began providing direct and indirect, specialized services to help stabilize patients on their medications. This expanded role by pharmacists helped patients function in society and outside of a hospital setting.2
This transition created the need for multidisciplinary teams to care for people living with mental illness and to promote their mental health.1 As the pharmacist’s role in mental health broadened, the pharmacist became more integral and participated in discussions about what drug to prescribe to patients living with mental illness.1 The goal here was for greater patient satisfaction and health outcomes.
Pharmacists are now important members of multidisciplinary teams. They work in various settings and with diverse health issues beyond mental health care. Their broad range of practice settings includes community centers, hospitals, veterans, prisons, and mental health centers. In addition to their dispensing functions, medication review, and providing education regarding medication use, pharmacists are now poised to participate in the optimization of drug therapy for patients as members of a multidisciplinary team.
Burnout in the Pharmacy Setting
The quantifiable significance of pharmacist interventions, including identifying and resolving medication errors and optimizing medication management, can be a source of career gratification and pleasure.3,4 However, this professional fulfillment may be tempered or displaced when a pharmacist is under stress, suffers from burnout, is anxious, or suffers from other feelings and issues.4
Burnout is a term that refers to a combination of exhaustion, cynicism, malaise, fatigue, and frustration, resulting from excessive demands on workplace energy, strength, or resources.3-5 These symptoms of burnout may impact the individual healthcare worker directly, and it may impact the patients under the care of the healthcare worker. Pharmacists may be asked to take an increased role in patient care amid prescriber burnout or due to increased professional practice responsibilities. This situation exacerbates an already potentially stressful environment since pharmacists are being asked to increase their practice responsibilities in patient care while confronting the risk of professional burnout. Pharmacists must engage in self-care to protect against stress, burnout, and other mental health issues.3,4
Mental Health and Mental Illness
Mental health issues have a significant impact on people, families, communities, and healthcare professionals providing care. In 2020, an estimated 52.9 million adults ≥18 years reported experiencing mental illness during the previous year. An estimated 12.2 million adults reported thoughts of suicide, and 13.8 million reported receiving treatment for depression during the same year.6 Pharmacy colleagues are among these statistics.
The link between mental illness and mental health is gaining focus in research settings and clinical practice. Having a mood or anxiety disorder is associated with significantly lower positive mental health. Although mental health promotion is largely devoted to the prevention and treatment of mental illness, continued efforts are essential to improve positive mental health.7
Mental health is a state of well-being in which life’s normal stresses can be handled. A person with good mental health can contribute to the community, experience accomplishments and milestones in employment, and have healthy relationships.8
Mental illness is a state of conditions that affects the way a person thinks, feels, behaves, relates to others, and impacts daily functioning. It is not the result of personal weakness or character flaws. Treatment by professionals should occur in these cases.9 According to the Centers for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Administration (SAMHSA), mental illnesses are among the most common health conditions in the United States.6
Global reports have found that healthcare workers have significant levels of self-reported anxiety, depression, and symptoms of post-traumatic stress disorder.10 Therefore, supporting the mental health of healthcare workers, including pharmacists, is crucial. The need for ongoing action in mental health is indisputable and urgent. Positive mental health has intrinsic, indisputable value and is integral to our well-being.
Recognizing Pharmacist Stress and Burnout
It is important to recognize signs of stress. Pre-existing or concurrent signs that someone is struggling might include:11,12
Feeling anxious or worried
Feeling depressed or unhappy
Weight or appetite changes
Being quiet or withdrawn
Feeling guilty or worthless
Changes in behavior or feeling
In one study of US clinical hospital practitioners, the burnout rate was high (61.2%) and largely driven by high emotional exhaustion.
The International Classification of Diseases (ICD-11) publishes the definition of burnout to emphasize a more detailed description and explain it as an occupational phenomenon. It is not currently considered a medical condition. Burnout in ICD-11 does include mention of energy depletion, exhaustion, increased mental distance from one’s job, negativism, cynicism, and reduced professional efficacy.13
There are many clinical and research tools for evaluating emotions and feelings. The Human Services Survey (MBI-HSS) is a tool for analyzing feelings in healthcare workers’ jobs. The MBI-HSS survey can be easily accessed online and measures emotional exhaustion, personal accomplishment, and other factors to identify burnout and possible cause of the stress associated with burnout.14
The MBI-HSS includes statements like “I feel emotionally drained from work” and “I feel used up at the end of the workday.” The survey also includes statements of “I have accomplished many worthwhile things in this job” and “I feel I’m positively influencing other people’s lives through my work.”14 By completing the survey and identifying burnout, efforts to address these feelings and sources may be possible.
Risk Factors and Causes of Stress and Burnout
Several subjective factors are predictors of burnout, including inadequate administrative time, the uncertainty of health care reform, and too many nonclinical duties. Other factors are difficult colleagues and the feeling that a person’s contributions are underappreciated.3 Pharmacists specifically reported differing causes for feelings of burnout. Time constraints, workload, performance metrics, and lack of control are typically associated with burnout.5 Rationing care, drug shortages, natural disasters, and pandemic responsibilities are contributors.16 Authors have reported that those who are single, without children, and working longer hours face increased risk.3,4
Challenges of clinical work, conflict with leadership, or technology limitations are some possible contributing factors to pharmacy team stress, burnout, and suboptimal mental health.3 Broad categories of risk factors for mental health issues include genetics, biological, family-related, and societal.11
Impact of Mental Health Issues
The impact of mental health concerns can manifest as physical, psychological, or occupational. Excess stress and burnout are associated with increases in negative physical outcomes. Physical consequences published in the literature include hypercholesterolemia, type 2 diabetes, coronary heart disease, hospitalization due to cardiovascular disorder, and musculoskeletal pain. Additional reported results include changes in pain experiences, obesity, fatigue, headaches, gastrointestinal issues, respiratory problems, severe injuries, and mortality below the age of 45 years.12
Published psychological effects are clinical presentations of insomnia, depressive symptoms, use of psychotropic and antidepressant medications, hospitalization for mental disorders, and psychological ill-health symptoms.
Job dissatisfaction, absenteeism, filing for new disability pension, job demands, and engaging job resources (e.g., autonomy and peer support) are identified as occupational outcomes associated with these issues. In one publication, workers with high levels of burnout (those ranked in the highest quartile) were absent from work, on average, 13.6 days per year, in comparison with those classified in the lowest quartile, missing 5.4 days.12
Serious negative effects can include an increased frequency of medical errors and diminished patient safety.16,17 Burnout has been linked to increased medication prescribing errors among physicians.4,5 This is particularly concerning when considering that medical errors are the third leading cause of death in the United States, behind only cardiovascular disease and cancers.17,18
Studies have indicated that healthcare practitioners are likely to suffer in silence due to the perceived stigma associated with experiencing “stress” and “mental illness,” as well as fear of having their professional license withdrawn.19
Coping Strategies for Managing Stress and Burnout
A 2018 review evaluates burnout in multiple healthcare professionals. It discusses strategies for burnout prevention in the available literature and identifies suggestions for addressing burnout.5 These suggestions are compiled in Table 1 and offer a framework to formulate action.5
Table 1: Suggested Coping Strategies
|Encourage leadership strategies that facilitate staff well-being
|Modify workplace incentives
|Base salary on performance-independent factors rather than productivity
|Encourage work-life balance
|Offer greater scheduling flexibility or time to work on preferred projects
|Encourage peer support
|Foster interdisciplinary collaboration
|Supply resources for self- care and mental health
|Provide adequate coverage for health appointments
|Target burnout from day 1
|Stress the importance of good mental health practices
Mental health protective factors occur throughout our lives and strengthen resilience after difficulties. Factors include our individual social skills, emotional skills, and attributes. Positive social interactions, quality education, appropriate work, and community cohesion can manifest as protective factors.8
Workplace training can provide benefits in coping with stress. One published multifaceted workplace training program implements a contact- based education approach with multiple sessions and discussions. It includes information tailored to the workplace context. It also incorporates varied
stakeholder perspectives, sufficient time to integrate and apply learning from the instruction, and organizational leadership support.20
Academic clinical training emphasizes that healthcare workers place patients first. Focusing on another direction, for awareness of the need for self-care, is critical for coping with stressful conditions. Suggested preventive self-care strategies include spiritual practices, relaxation techniques, using e- mental health services, and enhancing interpersonal skills. Evidence-based strategies include prioritizing close relationships, maintaining a healthy lifestyle, ensuring adequate sleep, and regular exercise. Finding time for vacations, fostering recreation and hobbies, practicing mindfulness, meditation, healthy eating, walks in nature, and allowing emotional processing are important.19
Common sense dictates that improvements in positive mental health should include decreased workload, decreased mental exhaustion, and improved achievement of quality measures. Focusing on the development of an improved work-life balance can be judicious for those who typically work more than 40 hours per week and are experiencing burnout.4
Professional societies and organizations at a national level are proposing tools for positive mental health. In 2017, the American Society of Health- System Pharmacists (ASHP) sponsors the National Academy of Medicine Action Collaborative on Clinician Well-being and Resilience. This network strives to raise the visibility of clinician anxiety, burnout, depression, stress, and suicide. It also aims to improve understanding of clinician well-being and challenges. It advances evidence-based solutions to improve patient care by caring for the caregiver.4
The American Society of Health-System Pharmacists Well-being & You program offers resources for pharmacists to prevent burnout, including community connections, well-being tools, and webinar series.4 Another professional organization, the Therapeutic Research Center (Pharmacist Letter), has also published resources to identify and address pharmacist stress and burnout.21,22
Pharmacy teams should engage available resources for assistance. It is important to emphasize that pharmacy professionals are not alone. Employee assistance programs, friends, loved ones, ministerial or spiritual resources, mental health specialists, and primary healthcare providers are available. To accommodate long work hours, there are resources in diverse formats, including recordings, webinars, written materials, text, and phone lines. Some national resources are communicated in Table 2 below.
Table 2: Resources for Pharmacists and the Community*
|American Society of Health- System Pharmacists’ State Affiliate Toolkit Well-Being and Resilience
|https://www.ashp.org/State- Affiliates/Affiliate-Resources/State-Affiliate- Toolkit-Well-being-and-Resilience
|Disaster Distress Helpline
|The Mental Health Foundation
National Academy of
Medicine’s Clinical Well-Being Knowledge Hub
|National Academy of Medicine Resource Compendium for Health Care Worker Well-being
|National Alliance on Mental Illness
1-800-950-6264 or text “nami” to 741741
|National Center for Victims of Crime
|National Domestic Violence Hotline
1-800-799-7233 or text “START” to 88788
|National Suicide Prevention Lifeline
|The National Institute of Mental Health
|Substance Abuse and Mental Health Services Administration (SAMHSA)
|Suicide and Crisis Lifeline
*There are many well-being and mental health resources for pharmacists and the community. This list is not all-inclusive. This is not an endorsement of any specific organization or process, it is only informational. This list is not intended to replace licensed professional medical advice.
The future of positive mental health begins today and includes digital solutions. Internet searches reveal novel digital apps to help avoid specific stressors and triggers. Other tools provide motivation to people.23
Hundreds of mood-tracking and mental health applications (apps) are available for download, and more innovative digital solutions will be developed. They do not replace in-person therapy. They do provide resources, symptom tracking, management options, and online support.
Healthcare provider mental health research is ongoing. Because intensive care unit (ICU) clinician burnout rates exceed 50%, a new STOPTHEBURN clinical trial is active to assess whether participation in regular debriefing sessions can prevent burnout in ICU clinicians. Target enrollment is 100 physicians and 100 non-physicians (nurses, pharmacists, and therapists). Informal discussions focusing on death, dying, loss, grief, and illness allow for reflection on distressing events and provide a strategy to mitigate burnout in this vulnerable population potentially.24
Stress, burnout, and mental health concerns can affect pharmacists in all practice settings. Pharmacists spend so much time helping patients, practitioners, administrators, loved ones, and others, it is critical to commit to
caring for oneself. A personalized approach to resources for self-care contributes to empowerment. Talk to friends or family, participate in enjoyable activities, avoid harmful substances, and talk to a professional.
Avoiding burnout, anxiety, depression, or negative physical outcomes, such as cardiovascular disease, enhances the quality of life. Addressing issues as they arise also contributes to positive mental health in career and home settings.
A pharmacy fills 1000 prescriptions per day, and one pharmacist and one technician just quit. The remaining pharmacist co-worker is presenting signs of stress and burnout. What is the best conversation with co-workers?
Share that global reports have found that healthcare workers have significant levels of anxiety and depression.
Symptoms of post-traumatic stress disorder are only possible in veterans but insomnia is possible; supporting worker health is crucial.
Emphasize their contributions are appreciated, and it’s OK that some nonclinical duties will not be completed while short-staffed.
The routine human resources protocol is for the remaining staff to complete MBI-HSS within 1 week of department staff departures.
Serious negative effects from stress and burnout, and poor mental health can include
loss of professional license.
risk of narcolepsy.
fewer medication errors.
Which fact best describes what pharmacy staff should know about mental health awareness?
Mental health promotion is largely devoted to the prevention and treatment of mental illness in institutional settings.
Burnout, according to ICD-11, is considered a medical condition and does include mention of energy depletion.
Time constraints, workload, performance metrics, and lack of control are typically associated with genetic causes.
The impact of mental health concerns can manifest as physical, psychological, or occupational experiences.
A pharmacy begins prescribing the newest COVID treatment. Corporate guidance has not been received. No training or protocol flow chart has been provided. The law is not understood, and the EPIC system password needs resetting. There is no ability to bill Medicaid or Medicare. A patient comes in (who takes 9 medications) with no labs, so the full prescribing information must be read before proceeding. What can staff do when the shift is over to de-stress?
Go for a walk
Pray or meditate
Call a best friend to express frustration
All of the above
The pharmacist evacuates before hurricane Ian hits Florida and then receives a call from a neighbor that the entire roof of their home is blown away. Stress is increasing. The pharmacist develops stomach pain and a headache. After being on the phone, holding for 40 minutes, reports the loss to the home insurance company, then asks oneself whom to call next. The pharmacist recalls a list of resources from a recent online pharmacy continuing education article, so the pharmacist goes online to retrieve the article and list. Which resource might best help this pharmacist feel less stressed?
Smart Recovery (1-440-951-5357)
Disaster Distress Helpline (1-800-985-5990)
NAM Clinical Well-Being Knowledge Hub
Suicide and Crisis Lifeline (988)
To help patients, staff, and themselves, pharmacists should recognize symptoms of stressful struggles. Which is not a sign?
Feeling eager or unconcerned
Feeling depressed or unhappy
Expressing emotional outbursts
Having problems sleeping
A pharmacist’s role is to be aware of mental health issues that might be present. Which statement correctly describes a struggling population?
In 2020, An estimated 52.9 million adults ≥18 years reported experiencing mental illness during the previous year.
In 2020, An estimated 122 million adults reported thoughts of suicide during the previous year.
In 2020, an estimated 1.38 million reported receiving treatment for depression during the same year.
In 2020, an estimated 5.29 million adults ≥18 years reported experiencing mental illness during the previous year.
A director asks for the pharmacy team to create a mental health awareness brochure for all pharmacy teams in the state to read. Which statement(s) should be included within topics to answer questions about mental health awareness?
The company appreciates the team for identifying and resolving medication errors and optimizing medication management despite a heavy workload.
There are many published resources to identify and address pharmacist stress and burnout from professional societies and national agencies.
Rationing care, drug shortages, natural disasters, and pandemics will not hinder career gratification.
a and b are correct
Which of the following provides the least effective risk reduction strategies to address pharmacy staff stress?
Spiritual practices, relaxation techniques, using e-mental health services, and enhancing interpersonal skills
Close relationships, maintaining a healthy lifestyle, emotional outbursts, being quiet or withdrawn, regular exercise
Finding time for vacations, fostering recreation and hobbies, practicing mindfulness, healthy eating
Walks in nature, decreased workload, allowing emotional processing, and adequate sleep
Which of the following is an accurate statement associated with burnout?
Burnout refers to exhaustion, cynicism, malaise, and well-being.
People with burnout experience fatigue and healthy relationships.
Prescriber burnout may lead to increased pharmacist role.
Burnout can result from few demands on workplace energy.
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Buselli R, Corsi M, Veltri A, et al. Mental health of Health Care Workers (HCWs): a review of organizational interventions put in place by local institutions to cope with new psychosocial challenges resulting from COVID-19. Psychiatry Res. 2021;299:113847.
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Salvagioni DAJ, Melanda FN, Mesas AE, González AD, Gabani FL, Andrade SM. Physical, psychological and occupational consequences of job burnout: A systematic review of prospective studies. PLoS One. 2017;12(10):e0185781. Published 2017 Oct 4.
World Health Organization. Burn-out an “occupational phenomenon”: International Classification of Diseases. 2019. https://www.who.int/news/item/28-05-2019-burn-out-an-occupational- phenomenon-international-classification-of-diseases. Accessed October 22, 2022.
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Motluk A. Do doctors experiencing burnout make more errors?. CMAJ. 2018;190(40):E1216-E1217. doi:10.1503/cmaj.109-5663
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