Community pharmacy: An untapped resource in suicide prevention?

By Hayley Gorton

Back in 2015, I attended the International Association for Suicide Prevention congress the first time. I found myself in a room with about 600 delegates including psychiatrists, psychologists, statisticians, epidemiologists and many others; but realised that I was probably the only pharmacist there. This made me reflect on my own practice as a pharmacist. What would I do if I was faced with somebody who was feeling suicidal? I didn’t know.

I was part way through a PhD in the epidemiology of suicide and I did not know how I would use this knowledge in my practice. I wondered if my peers felt the same. I therefore made it my mission to begin sharing my learning and, ultimately, understand this more formally through a robust research study. In the UK, pharmacists work in various settings. The sector that I and many others practice in, is community pharmacy. In England alone there are over 11,000 pharmacies and 1.6 million people visit a community pharmacy every single day [1]. Yet, until recently little attention has been paid to the contribution that’s pharmacy teams might make to suicide prevention. In the UK, a quick succession of policy promises have been issued [2-4]. They aim to work towards the 10% reduction in suicide rates by 2020, the same target set by the World Health Organization [5]. Many of these documents highlight the value of Primary Care in suicide prevention. Pharmacy is rarely explicitly considered. In the Suicide and Self-harm Competency Frameworks published in October last year, pharmacy teams are acknowledged as frontline clinical professional teams [6], but no details of expectations were given.

I have led a piece of qualitative research university of Manchester with Dr Donna Littlewood and others, which has been published in PLOS ONE today, on World Suicide prevention day [7]. We conducted in-depth qualitative interviews with 25 community pharmacy staff and identified 6 key themes. The first two; Relationship with patient and suitable Pharmacy environment formed a basis for interacting about suicide. If supported by Training, staff felt that they could maximise Opportunities for Contact. The need to create Facilitated referral pathways and understand more about Restricting access to means was recognised.

I was also fortunate enough last year to travel to America and Canada as part of fellowship of the Winston Churchill memorial Trust [8]. I spent a month meeting with the very few people worldwide who specifically study pharmacy and suicide prevention and have set up an international collaboration with some of these people. Using the knowledge from both our research and my Fellowship I have worked with the centre for postgraduate pharmacy education to produce an on the sofa interview about suicide awareness. We launched this video today World Suicide Prevention Day. It is no accident that we have chosen today to launch this work. We have done so to really raise suicide prevention as a priority within the profession.

Gladly, we are singing to the choir, as in July the new Community Pharmacy Contractual Framework for England was published. It included a commitment to  suicide prevention training for all community pharmacy staff in 2020/21 [9]. I hope to have the opportunity to continue informing this work from the experiences I have been fortunate to have in this research area, so that we can make a difference to patients, the public and each other.

References

1. About community pharmacy [Internet]. 2019 [cited 23 Aug 2019]. Available from: https://psnc.org.uk/psncs-work/about-community-pharmacy/
2. HM Government H. Preventing suicide in England: Third progress report on the cross-government outcomes strategy to save lives [Internet]. 2017 [cited 29 July 2019]. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/582117/Suicide_report_2016_A.pdf
3. Public Health England. Local suicide prevention planning [Internet]. 2016 [cited 29 July 2019]. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/585411/PHE_local_suicide_prevention_planning_practice_resource.pdf
4. Public Health England & National Institute for Health and Care Excellence. Preventing suicide in community and custodial settings [Internet]. 2018 [accessed 29 July 2019]. Available from: https://www.nice.org.uk/guidance/ng105/resources/preventing-suicide-in-community-and-custodial-settings-pdf-66141539632069
5. World Health Organization. Preventing suicide A global imperative Geneva [Internet]. 2014 [cited 29 July 2019]. Available from: http://www.who.int/mental_health/suicide-prevention/en/.
6. Health Education Englan. Self-harm and Suicide Prevention Competence Framework: Adults and older adults [Internet]. 2018 [accessed 29 July 2019]. Available from: https://www.ucl.ac.uk/pals/sites/pals/files/self-harm_and_suicide_prevention_competence_ framework_-_adults_and_older_adults_8th_oct_18.pdf
7. Gorton HC, Littlewood D, Lotfallah C, Spreadbury M, Wong KL, Gooding P, Ashcroft DM. Current and potential contributions of community pharmacy teams to self-harm and suicide prevention: a qualitative interview study. PLOS ONE. 2019; https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0222132
8. Gorton HC. What could UK community pharmacy teams learn from the United States and Canada about their role in suicide prevention? Clinical Pharmacist [Internet]. 2019 [cited 29 July 2019];11(3). Available from: https://www.pharmaceutical-journal.com/research/perspective-article/what-could-uk-pharmacy-teams-learn-about-suicide-prevention-from-north-america/20206034.article
9. Department for Health and Social Care. The Community Pharmacy Contractual Framework for 2019/20 to 2023/24: supporting delivery for the NHS Long Term Plan. London: Department of Health and Social Care [Internet]. 2019 [accessed 29 July 2019]. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/819601/cpcf-2019-to-2024.pdf

Hayley Gorton (@hayley_gorton) is a Senior Lecturer in Pharmacy Practice at the University of Huddersfield, England (H.C.Gorton@hud.ac.uk).

*Featuring photo by Tbel Abuseridze on Unsplash.