Mental health services for marginalised women
By Geraldine Esdaille,
I am a pharmacist and have been exposed to mental health problems and drug misuse among service users in community pharmacy. In 2014 this motivated me to undertake a PhD looking at suicide, using data from large electronic health records. Then in 2015 I found myself as the only pharmacist amongst 800 delegates at a large, international conference on suicide prevention. It was at this point that I made it my mission to share my PhD learnings with my colleagues in pharmacy, and work towards support and training for pharmacy teams.
"Having community pharmacy teams recognised as allies in suicide prevention means that there is a team of frontline, accessible, community-based health professions willing to support people at risk." - Hayley Gorton, Fellow
In 2018, I was generously granted a Churchill Fellowship to visit other leaders in suicide prevention in pharmacy, in Canada and the USA. Since my return, I have continued this work, supported by colleagues at my previous institution, the University of Manchester, and in my current role as Senior Lecturer at the University of Huddersfield.
Following my Fellowship, I came up with the following recommendations for involving pharmacies in suicide prevention.
1. Clear referral pathways for community pharmacy teams
I noticed parallels between my Churchill Fellowship discussions and our work in the UK, which pharmacists are often missing in the so called ‘circle of care’. This works both ways. Sometimes pharmacists aren’t given the full picture of a person’s situation, even following a hospitalisation for example. On the other hand, there are often not clearly defined referral pathways for pharmacists to supportively transfer people to other parts of the healthcare system. This should be a focus.
2. Understanding the role of pharmacy teams in other sectors
Our work, and that of colleagues internationally, is focused on community pharmacy teams. This makes sense: community pharmacy teams are first line, accessible healthcare professionals. However, through this work I’ve had plentiful and encouraging anecdotal conversations with pharmacists in other sectors, including specialist mental health services, general hospitals and general practice (GP). The extent of these roles needs to be understood.
3. Medicines involved in suicide
So far, much of our focus has been on what I call the ‘social, clinical and holistic role’ of pharmacy teams. My focus now is on medicines involved in poisoning. I intend to bring my expertise as a pharmacist and epidemiologist to lead work on this area.
Currently I am researching the role of pharmacy teams in suicide prevention. In addition to the findings from my Churchill Fellowship, my team and I have published an interview study and, along with collaborators from the Churchill Fellowship, we have conducted the largest survey of pharmacy teams in the UK about their experience and attitudes towards suicide prevention. We are preparing this study for publication and look forward to sharing the results.
In both my Churchill Fellowship and our qualitative study, I recommended that community pharmacy staff undertake gatekeeper training. In 2021, community pharmacy teams in England were incentivised to undertake the Zero Suicide Alliance training. Today over 72,000 pharmacy staff in 10,631 pharmacies in England have had this level of suicide prevention training. For the first time, community pharmacy teams have been identified as part of the multidisciplinary team who can contribute to preventing self-harm and suicide in the draft NICE guidance on self-harm. This recommendation was based on evidence by our work.
Having community pharmacy teams recognised as allies in suicide prevention means that there is a team of frontline, accessible, community-based health professions willing to support people at risk. Much of this role will involve triaging people, where improved access and referral pathways will support our pharmacy teams to support the public.
The views and opinions expressed by any Fellow are those of the Fellow and not of the Churchill Fellowship or its partners, which have no responsibility or liability for any part of them.
By Geraldine Esdaille,
By Lorraine George,
By Sophie Redlin,