Since restrictions on lockdown have begun to ease - and many GP surgeries and mental health services remain closed - pharmacy teams have noticed a rise in people showing mental health issues

Professor Neil Greenberg, a consultant psychiatrist at King's College London, offers some advice to pharmacy teams on how to help people who come into the pharmacy with mental health difficulties.

Why the sudden increase in cases?

The Covid-19 pandemic has had a dramatic impact on most people’s way of life. The direct impact of the virus, and the nation’s response to it, has been a challenge for most people to deal with. Some, especially those in higher-risk groups, are likely to have developed mental health disorders such as depression, anxiety disorders or even post-traumatic stress disorder. 

However, the secondary impact of the crisis, such as financial and relationship difficulties, bereavement, and being unable to access care for acute or chronic healthcare problems, is likely to impact on people’s mental health even more. For example, a recent Centre for Mental Health report predicts that around 500,000 people may experience mental health difficulties as a result of just the financial impact of the pandemic.

With many primary care providers providing limited face to face services, people who experience mental health difficulties will likely find the face to face contact with pharmacy staff particularly attractive. However, given their limited mental health training, many pharmacy staff may find themselves at a loss to know how to assist customers with mental health difficulties.

First off, it is worthwhile remembering that most people who seem a bit glum or anxious are unlikely to have a formal mental health difficulty. Data from the 2014 Adult Psychiatric Morbidity study suggests that at any time around 1 in 6 people are experiencing a mental health problem; however, this may have increased a little because of the pandemic. 

Some useful tips:

People with mental health difficulties may find it hard to express themselves clearly and it is, therefore, helpful to apply all the normal rules of good communication when speaking with them. Make sure you listen well and use non-verbal encouragement such as nodding your head or saying ‘hmmm’ or similar to show you are paying attention. 

Try looking at the end of someone’s nose if you find making eye contact hard. Also, it is worth summing up what you think they have said before providing your advice to avoid misinterpretation. 

People with mental health problems are often portrayed as being irritable, or even violent - this sort of behaviour is unlikely. Personality difficulties and substance misuse are far more likely causes of those sorts of behaviours. With this in mind, it may sometimes help to move to a quiet area of the pharmacy for privacy if it seems that an individual is having difficulty articulating their needs.

Once you have properly understood their wishes, then consider whether there is any likelihood of risk associated with the request being made. Although self-harming behaviours are thankfully uncommon, and suicide less so, you should ask yourself the question as to whether the desired product may be intentionally misused. Should you need to ask about suicide, you can be reassured that doing so does not increase the risk of it happening. If you think someone is at risk, then you should take appropriate action to mitigate the risk (e.g. helping them to call their GP or an ambulance or in extremis, you can call the police).

Whilst you may be able to supply psychotropic medication when someone has run out, advise on products to help with sleep or reduce distress, or provide physical health products, it is also worthwhile ensuring you are aware of local statutory and voluntary groups which may provide mental health support or care. Examples of these are MIND, NHS IAPT services in England, and equivalents in the rest of the UK, and the Samaritans. It is worthwhile knowing that the Samaritans provide a listening service for anyone in distress, not just people who are thinking of ending their lives. If a customer works for the NHS, then advising the nationally offered mental health support.

There’s no need to feel less confident when speaking to someone who may have mental health problems. Listening well and serving the customer with compassion while keeping the possibility of risk at the back of your mind, should be all you need to do.