Improve mental illness patient care | 4 steps to follow


Recognize depression among the chronically ill and be ready to discuss treatments

In brief:

  • More than 19 million U.S. adults are treated for mental illness annually.1
  • Many people dealing with chronic illnesses also experience depression and mental illness, making it more difficult to stay on track with medications and other treatment.
  • Because pharmacists frequently see patients, you are in a great position to recognize issues and address them to improve patient care.

The prevalence of mental health issues

About 1 in 17 Americans has a serious mental illness, such as bipolar disorder or schizophrenia. However, 1 in 5 Americans experience some type of mental illness each year, which can include anxiety.2

Depression and chronic illnesses

Up to one third of the patients who fill medications at your pharmacy for chronic conditions such as diabetes and coronary artery disease may also be depressed, as well as many individuals with other chronic diseases.3 These mental health issues can affect patients’ ability to adhere to treatment.

Rates of depression among patients with other medical illnesses:

  • Heart attack: 40%–65%
  • Coronary artery disease (without heart attack): 18%–20%
  • Parkinson’s disease: 40%
  • Multiple sclerosis: 40%
  • Stroke: 10%–27%
  • Cancer: 25%
  • Diabetes: 25%

Source: Cleveland Clinic3

Barriers to assisting patients

Despite the prevalence of mental illnesses, often pharmacists are not seen as a resource to assist patients. Even patients who have a strong relationship with their pharmacist may not think the pharmacist is interested in their mental health condition.4 And, while counseling can improve adherence to antidepressants and antipsychotic medications, some pharmacists don’t feel comfortable offering that counseling.5

The role of pharmacists

To better care for patients, pharmacists should consider these actions:

  1. Screen for depression. Because many patients are in your pharmacy at least monthly, that gives your staff the opportunity to notice changes in mood or behavior. Asking a few questions about how a patient has felt over the past two weeks can help you determine whether to ask the nine questions for the Patient Health Questionnaire, PHQ-96 (See “Community pharmacists can help spot depression, improve outcomes,” Pharmacy Today, May 2017.).
  2. Communicate with compassion. Many of the practices that are important for working with patients who have a mental illness are also important for offering great customer service for all. These practices include:
    • Offering a private area for counseling and speaking in a calm and respectful manner.
    • Communicating clearly and simply, and paying attention to their body language and words.
    • Being patient, giving individuals time to think and respond when you ask a question.
  3. Set the expectations. Take time to explain that patients may not see improvements in their mood until weeks after they begin taking a medication, and be sure they understand why they should not suddenly stop taking it.7
  4. Know the supplements. Just as you may discuss the benefits of Coenzyme Q10 for a patient experiencing myopathy while taking a statin, be ready to discuss the latest research on supplements for mental health conditions, such as l-methylfolate in the treatment of depression.8

The patients who walk into your pharmacy every day aren’t just living with asthma, diabetes and cancer. Many are suffering from anxiety, depression, attention deficits, post-traumatic stress disorders and other mental health issues. Being comfortable talking about mental health conditions with your patients will not only improve medication adherence, but also deepen your patient relationships in a positive way.

1 “Mental Illness,” National Institute of Mental Health, LINK
2 “Mental Health Conditions,” National Alliance on Mental Illness. LINK
3 Cleveland Clinic, Chronic Illness and Depression, LINK
4 “Pharmacy Reaches Out to Patients with Mental Health Issues,” David D. Pope and Ashlee Riggs, Drug Topics, June 15, 2013. LINK
5 “Barriers to Counseling Patients with Mental Health Disorders,” Kiran Panesar, U.S. Pharmacist, Nov. 17, 2016. LINK
6 “Community Pharmacists Can Help Spot Depression, Improve Outcomes,” Loren Bonner, Pharmacy Today, May 2017. LINK
7 “Improve Counseling of Patients with Mental Health Conditions,” Maria G. Tanzi, Pharmacy Today, Feb. 1, 2013. LINK
8 “Assessing Effects of L-Methylfolate in Depression Management: Results of a Real-World Patient Experience Trial,” Richard C. Shelton, et al., Primary Care Companion for CNS Disorders, Aug. 29, 2013. LINK

Note: The information provided here is for reference use only and does not constitute the rendering of legal or other professional advice by McKesson. Readers should consult appropriate professionals for advice and assistance prior to making important decisions regarding their business. McKesson is not advocating any particular program or approach herein. McKesson is not responsible for, nor will it bear any liability for, the content provided herein.