Experience and attitudes of pharmacy teams towards suicide prevention: A cross-sectional survey

Pharmacists as gate keepers in suicide prevention: Assessing support needs of pharmacy teams

BACKGROUND

Gatekeeper training is an effective suicide prevention strategy. Pharmacy teams are among the most visible and accessible health care providers, making them important as possible gatekeepers. Given the pharmacists' role in dispensing medication, which is a common method of suicide and suicide attempts in Flanders and internationally, they are uniquely positioned to contribute to suicide prevention-not only by restriction or management of means but also by engaging with individuals at risk and facilitating referrals to appropriate care.

OBJECTIVES

This study aimed to assess pharmacy teams' support needs regarding their role as gatekeepers in suicide prevention.

METHODS

Participants completed an online questionnaire examining their perceptions, attitudes, perceived barriers in suicide prevention, self-efficacy, and need for gatekeeper training. Furthermore, experience with suicide(prevention) and suicidal behavior among pharmacists was investigated.

RESULTS

A total of 110 participants gave an informed consent, of whom 69 (62.7%) completed the questionnaire. Although nearly three-quarters (73.6%) had encountered suicidal individuals in their pharmacy, only 9.7% felt confident addressing potential suicide risk. Moreover, many indicated that they lacked training in screening mental health issues (81.8%) and did not know which actions to undertake with suicidal individuals (64.8%) or how to ask about suicidal thoughts (63.6%). Most participants indicated the need for training (91.3%), and nearly all (97.1%) were willing to follow such a training. They preferred an online training, including topics such as recognizing signs, starting a conversation about suicide and referring to other caregivers.

CONCLUSION

These findings contribute to the growing body of evidence on the important role of pharmacists as gatekeepers in suicide prevention and provide insight into their current perceptions, attitudes, and barriers. The study identifies the topics of importance for inclusion in a gatekeeper training. Overall, this study shows a clear need and willingness to participate in such a training among pharmacists.

A mixed-methods cross-sectional study to evaluate the public acceptability of a novel pharmacy-based response service for domestic abuse and/or suicidal ideation

BACKGROUND

Domestic abuse (DA) and suicidal ideation (SI) are prevalent and often co-occur. Numerous practical and psychosocial barriers inhibit help-seeking, including accessibility and confidentiality concerns. Early intervention and referral are essential for both DA and SI. Pharmacies are accessible and may be perceived as a discreet venue for a DA and SI response service. There is a growing body of literature about the role of community pharmacy teams in suicide prevention and assisting domestic abuse victims globally. Whilst there have been some interventions in UK pharmacies to support domestic abuse victims and encouragement of staff training in suicide prevention, there is currently no commissioned service for DA and/or SI in pharmacies in the UK.

OBJECTIVE

To assess public acceptability of a novel response service in community pharmacy for people in danger from domestic abuse and/or suicidal ideation.

METHODS

Data collection consisted of an online public survey running for 6 weeks and qualitative interviews with pharmacy customers. Descriptive statistics were used to present the survey results and interviews were audio recorded, transcribed verbatim and then analysed using the Framework Analysis method and NVivo 11.

RESULTS

The majority of 501 survey respondents and all 12 customer interview participants were supportive of offering a response service for DA and/or SI in community pharmacy. Participants emphasised the need for appropriate staff training and support. They considered it an ethical and accessible approach and the majority said that they would recommend such a service to family or friends, and use it themselves if needed. However, awareness of the service was low and marketing materials were considered insufficiently clear.

CONCLUSIONS

There is strong public support and acceptability for a response service covering both suicidal ideation and domestic abuse in community pharmacies. Further research is required to develop appropriate marketing materials.

Does video e-learning improve pharmacy teams' attitudes and preparedness towards suicide prevention?

Background

Evidence on the role of pharmacy teams in suicide prevention is growing. To support pharmacy teams, a video e-learning was produced by the Centre for Pharmacy Postgraduate Education (CPPE) involving an 'on-the-sofa' style group interview with people with personal and professional experience of suicide and suicide research.

Objective

The objective was to measure any change in attitudes and preparedness for suicide prevention, following a video e-learning produced for pharmacy staff.

Methods

People working in any sector of pharmacy in England and who accessed the training video were invited to complete a pre- and post- training questionnaire, between September 2019 and March 2021. Question types included demographics, experiences, attitudes as measured by the Attitudes to Suicide Prevention (ASP) scale, and preparedness. Descriptive statistics were used to summarize demographics and experience and paired t-tests were used to compare pre- and post- questionnaire responses.

Results

Both questionnaires were completed by 147 people. Most worked in community pharmacy (88%) and were pharmacists (64%) or pharmacy technicians (20%). Attitudes to suicide prevention improved significantly (pre:31.20 (SD 6.04); post:28.40 (SD 6.50), p < 0.0001) after watching the video, as did self-reported preparedness.

Conclusions

Pharmacy teams' self-reported attitudes and preparedness for suicide prevention improved after watching this suicide awareness video compared to baseline. Suicide awareness training tailored to pharmacy teams may be valuable, but the longitudinal impact of any suicide prevention training requires further exploration.

Community pharmacist encounters with patients displaying suicide warning signs: a cross-sectional survey

BACKGROUND

Mental health is a prominent public health issue exacerbated by the coronavirus disease 2019 pandemic. Community pharmacists are positioned to contribute.

OBJECTIVES

This study aimed to describe Iowa community pharmacists' encounters, confidence, behaviors, and training needs related to patients with suicide warning signs and explore relationships between demographics and previous training with encounter frequency, confidence, and behaviors.

METHODS

A cross-sectional survey was mailed to a sample of community pharmacists in Iowa. Three contacts were made between May and June 2022 including a prenotification letter, survey with a paid return envelope, and reminder postcard, each with a QR code for optional online completion. The survey included demographics, suicide warning sign encounter types, confidence, suicide prevention behaviors, and suicide prevention training history and needs. Analysis of variance and t tests compared differences between demographics and previous training with encounter frequency, confidence, and behaviors.

RESULTS

The response rate was 18.3% with 161 survey completions. Pharmacists reported encounters with patients who appeared distressed (96.3%), made concerning statements related to suicide (23.8%), and disclosed suicidal thoughts (8.8%). A minority of pharmacists had asked patients about suicide (21.1%) or referred them to crisis resources in the past year (17.4%). A third had previous suicide prevention training (37.9%), which was associated with higher levels of confidence (P < 0.001) and intervention behaviors (P < 0.05). Respondents expressed interest in training, particularly on intervention and referral.

CONCLUSIONS

This sample of community pharmacists encountered patients with suicide warning signs. Providing more pharmacists with training and support in understanding local mental health resources and referrals may increase their confidence and engagement in suicide prevention.

Evaluation of an online advanced suicide prevention training for pharmacists

BACKGROUND

With the pharmacist role extending internationally to include health promotion and harm reduction, pharmacists are well-suited to adopt a frontline role within suicide prevention efforts. To maximise their abilities to implement suicide prevention strategies, suicide prevention training is essential to improve pharmacists' knowledge of, attitudes towards, and confidence in pharmacy-based suicide prevention.

AIM

This study aimed to evaluate the impact of an online Advanced Suicide Prevention Training for Pharmacists and explore how participant feedback may direct training improvements.

METHOD

One hundred and fifty pharmacists in Tasmania, Australia, completed the training. Of these, 109 participants completed surveys pre-, post- and 6-months post-training to evaluate changes in suicide prevention knowledge, confidence, and attitudes, and explore participants' perceptions of the training.

RESULTS

Significant improvements were observed in suicide prevention attitudes (F(2, 20) = 4.12, p = 0.032, partial η2 = 0.292), and self-efficacy (F(2, 20) = 7.84, p = 0.003, partial η2 = 0.439), across the three timepoints, with improvements to knowledge and confidence evident between pre- and post-training (p < 0.05). Qualitative data reflected that the training was beneficial in aiding the identification and support of at-risk individuals, however barriers such as the pharmacy setting, personal discomfort, and perceptions of the pharmacist role were identified as impeding the implementation of suicide prevention within pharmacy practice.

CONCLUSION

Training is an effective means of improving pharmacists' suicide prevention knowledge, confidence, and attitudes. While personal barriers to suicide prevention improved, contextual and social barriers continue to impede pharmacists' implementation of suicide prevention in practice.

A needs assessment for suicide prevention training within community pharmacies

Background

Suicide is a leading cause of deaths globally, with over 700,000 deaths by suicide reported annually. In Ireland, numbers of suicides increased by 5.4% from 2015 to 2019. Community pharmacists are one of the most accessible and trusted healthcare professionals, and together with their staff they are well placed to identify those who may be at risk of suicide and guide them towards care pathways. Furthermore, their role in medication management can limit vulnerable patient access to potentially harmful medications. This study aims to explore the experience of community pharmacists and their staff in dealing with patients at risk of suicide and to identify ways of increasing education and support in this area.

Methods

Pharmacists registered with the Pharmaceutical Society of Ireland (PSI) were invited to complete an anonymous online survey via Google Forms in May 2020, and to circulate the online survey link to their community pharmacy staff (CPS). The survey comprised 29 questions across the following categories: interactions with at-risk patients; communication; training and resources. Free text responses to the following question were invited: "Without any identifying information, please tell us briefly about a time when you interacted with a patient who you were concerned may hurt himself or herself". Data were analysed using descriptive statistics and thematic analysis.

Results

Of 219 eligible responses (67% female, 94% pharmacists, 6% other pharmacy staff), 61% percent (n = 134) reported having a patient die by suicide. Forty percent (n = 87) of participants reported feeling either very or moderately uncomfortable communicating with patients that may be at risk of suicide or self-harm. Most respondents (88.5%, n = 194) had not completed any suicide training. Online/webinar style trainings (82.1%, n = 180), and local/regional in-person events (50%, n = 111) were the most preferred education mode. Qualitative themes that emerged were: (i) accessibility; (ii) medication management; (iii) therapeutic relationship; (iv) knowledge and training; and (v) continuum of care pathways.

Conclusion

This study highlights the high frequency of community pharmacy interactions with those at risk of suicide and the necessity for appropriate training in suicide prevention. Further research-informed action is required to facilitate navigation of such interactions with knowledge and confidence.