It's not all in your head. Overworked, under stress and unable to cope — what happens when pharmacists become the patients? Léa Legraien reports

In 2015, Alison Stamps, a pharmacist from Ouston, wasn’t able to cope with the demands of her job anymore and died by suicide.

In October, her case prompted a discussion in Parliament about the role of employers and the General Pharmaceutical Council ‘in supporting and preventing poor

mental health in the workplace’.

Some politicians believe her death could have been prevented.

Jackie Doyle-Price, minister for social care and mental health, said that the ‘buck stops with the employers, who must ensure that there is sufficient mental health support for their workers’.

She said: ‘There is political consensus that we must address issues, such as suicide prevention. So now is the time for us all to take action to make change a reality for people and communities.

‘I hope that improving mental health awareness and creating more mentally friendly and healthy workplaces will increase the likelihood that people will feel able to talk about their mental health problems at work and be assured they’ll get the understanding and support they need.’

All too common

Sadly, Alison’s case is far from uncommon for pharmacists. Between 2011 and 2015, there were 23 suicides among this group.

In the UK, one in four people will experience a mental health problem in their life. Although many are able to live with their condition or fully recover, some don’t.

With mental health conditions so commonplace, it stands to reason that many pharmacists suffer from their devastating effects. But evidence suggests that serious mental health conditions may be more likely to hit pharmacists than other professions.

According to a spokesperson for the Office for National Statistics, the risk of suicide among male pharmacists falls in line with the national average, while it is above that for female pharmacists. Additionally, the standardised mortality ratio for female pharmacists reveals that the risk of death by suicide is 2.22 times higher than the national average.

As frontline healthcare professionals, pharmacists play an important role in looking after people’s mental health.

But who looks after the pharmacists when they become the patients?

Stressful profession

As in other health professions, being a pharmacist can be highly stressful. In some ways, working in a pharmacy is similar to working in a pressure cooker: there are many factors that individually don’t amount to much but when combined can create stressful situations.

It’s a challenging role to bridge professional healthcare and run a business. Add to that a slew of funding cuts and other clawbacks, and you have a sector under serious pressure.

Michael Champion, a pre-registration trainee, almost died by suicide in 2016 after he was diagnosed with low mood and generalised anxiety the previous year.

He says there are options out there to support those experiencing issues with their mental health.

‘Pharmacists shouldn’t be afraid to seek help from their local wellbeing service or through the full gamut of treatments and therapies, which may include GP or inpatient treatment,’ he says.

‘Employers should be proactive in offering access and signposting to support charities or services offered by representative organisations, and ensure that occupational health assessments act as a gateway to assistance if an employee feels they need these services.’

A female issue?

The higher incidence of death by suicide among female pharmacists could be attributed to many different factors.

A female clinical pharmacist, who wished to remain anonymous, believes that in general ‘women tend to take a lot more on with juggling family and work’.

She says: ‘There aren’t enough part time opportunities, family planning in the career succession structure, coupled with a lack of females in leadership and higher management positions.’

She tells The Pharmacist that she went through depression and anxiety due to stressful work conditions. She claims that she doesn’t get any support where she works, because ‘there’s no concept of mental health’, and has had to pay for her own cognitive behavioural therapist.

Thousands of pharmacists, one charity

Pharmacist Support is the only charity supporting pharmacists and their families, pharmacy students and former pharmacists across the country.

Its chief executive Diane Leicester-Hallam says that if there is a number of support services and initiatives aimed at doctors, dentists or nurses, ‘there seems to be a gap in support for pharmacists’.

In 2016 alone, the charity dealt with more than 1,000 enquiries from individuals dealing with stressful situations.

This year, enquiries are up by 37% compared with 2016, with employment and pre-registration trainees continuing to be the largest areas of enquiry.

Other concerns raised include low staffing levels, a lack of breaks, low rates of pay in some areas, heavy workloads and onerous targets.

The Government’s funding cuts on the English community pharmacy budget, set out in 2016, have also contributed to low morale and high stress levels of pharmacy staff.

Ms Leicester-Hallam says: ‘Stress connects many of the calls and emails we receive at Pharmacist Support. Reports of low morale are relatively common among our enquirers.

‘Often, the pharmacists we speak to inform us that they no longer feel valued for a variety of reasons, such as an inability to put patients first, a discontentment with a target driven environment or a lack of acknowledgement as to the diverse and demanding nature of the role today.’

In October 2017, the charity reported that discipline, bullying, terms and conditions and workplace stress accounted for more than half of all employment enquiries it receives.

Profit first, patients and staff second

For some pharmacists, mental health issues may be exacerbated or even caused by the stress heaped on them by insensitive employers.

Simon Jacklin, a student and locum pharmacist, says: ‘A pharmacist can close the pharmacy if it feels unsafe but this is difficult with huge national companies behind you who have taken their own employees to fitness-to-practise hearings over the most trivial of things.

‘With this sort of bullying and intimidation hanging over us, it’s no wonder we feel anxious. The balance needs shifting away from profit and back to people, both patients and staff.’

Acknowledging a mental health issue is no easy task. But it can prove harder if your working environment breeds a mentality of fear and apathy.

Mr Jacklin believes that isolation and disillusionment are some of the reasons behind mental health issues in pharmacy. When he started suffering from anxiety, he wanted his colleagues to see him as a ‘strong and capable’ person and work on his problem on his own.

‘I found some members of staff where I worked to be very insensitive to others’ emotions and concerns,’ he explains. ‘When I locum in the community, I’m in charge of up to six or seven people at a time who have nowhere near the clinical knowledge I have.

‘This means I have to take all clinical decisions on my own. I have experienced dispensing staff trying to urge me to just dispense or give something out because it’ll keep the patient happy.

‘I know it to be wrong, but you have to push back and stick to your guns, which is hard.’

A devalued profession

As gatekeepers of NHS England, community pharmacies play more than just a clinical role. Yet, there is a lack of recognition of the value of pharmacists.

Mr Jacklin says: ‘Pharmacists are often treated like shopkeepers, which doesn’t seem to happen to other professions. This means that patients are often expecting us to just hand them a box of pills and that’s it.

‘When we have to take the time to prepare their prescriptions and fill out various paperwork, they become agitated and annoyed and this heaps on pressure unfairly.’

Working together

To help the sector recognise the signs and symptoms of stress and deal with everyday pressures, Pharmacist Support created free Wardley wellbeing workshops.

Ms Leicester-Hallam says: ‘When it comes to stress, it is important to recognise the signs, to try and understand why you feel the way you do and to do something about it.

‘Talking alone may not resolve issues but it can be a first step in identifying the options available and starting to deal with the problem.

‘Problems don’t normally just go away on their own and the longer they are left, usually the worse things can get.’

Investing in a brighter future

Many pharmacists may be reticent to open up about their mental health issues for fear of it impacting upon their career prospects.

But Mr Jacklin is keen to see attitudes change. ‘Mental health issues don’t mean someone isn’t able to cope with stress and work hard,’ he says. ‘It could mean that once in a month or so, they need to maybe come in half an hour later so they can compose themselves.’

Luckily, it seems that perceptions of mental health may finally be starting to shift. In January 2017, Prime Minister Theresa May set out a series of measures to improve mental health access.

The Government has committed to deliver £1bn of funding annually by 2020/21 to ‘ensure that an additional one million people can access mental health services’.

Whether it’s about raising awareness, improving access to services or investing in innovative programmes, pharmacists and pharmacy staff shouldn’t be afraid of speaking up about their mental health issues.

It’s time that pharmacists started treating themselves with the same compassion they show patients, so the stigma of mental health problems can stop being an issue once and for all.

What to do if you are struggling

Call Pharmacist Support’s freephone number on 0808 168 2233 or visit Alternatively, call the Samaritans 24 hours a day on 116 123.