Data have shown there is a rising need for mental health and substance use disorder services, yet there is a shortage of psychiatrists in the country that is estimated to worsen by 2024.
With the high rates of mental health and substance use disorders (SUDs) in the United States today, pharmacists have the opportunity to step forward and provide services to fill current gaps in care for patients at a pivotal time, explained Erin Shaal, PharmD, vice president of Rx Procurement, Specialty and Patient Care Services at Albertsons Companies, during a session at the 2022 National Association of Chain Drug Stores Total Store Expo.
Shaal explained that in 2020, a survey conducted by Substance Abuse and Mental Health Services Administration (SAMSA) showed that the prevalence of mental health disorders and SUDs in the United States was rising. Specifically, the survey showed that there were 52.9 million Americans with any psychiatric disorder and 14.2 million Americans with a serious psychiatric disorder that year.
“Due to this, we’re looking at complex patients and patients who are needing additional help,” said Shaal. “If you look at the numbers, we also have 17 million patients that are aged 18 or older that have a mental illness and [SUD]. So we have a need within society today that is unmet.”
Shaal noted that this unmet need in mental health care raises the question regarding how pharmacists can fill in these gaps, especially in light of the ongoing shortage of psychiatrists in the country that is estimated to potentially worsen by 2024.
“Through the year 2024, we’re likely to see a shortage of anywhere from approximately 24,000 to 31,000 psychiatrists in the United States. So where do we play a role? This is something that I think of constantly on a day-to-day basis,” Shaal said.
At Albertsons, Shaal noted that the company has a mental health program and a SUD program available to patients as a part of their patient care service offerings. However, Shaal notes that there is still room for growth in terms of how pharmacists assess the need for these services and programs for a growing numbers of patients.
“I think about, with us being the most accessible health care providers, how do we provide care to patients in need, and meet them where they’re at,” Shaal said. “So, with the gap in care, how can pharmacists jump in and provide these services?”
Shaal explained that the increasing use of screening questionnaires may play a valuable role.
“I see that many different individuals right now in the pharmacy space are incorporating these screening questionnaires within the different services that they’re providing. So the first one is consent forms—can we add additional questions to the consent forms for immunizations and other services that we’re providing? I’ve seen pharmacies add the [Patient Health Questionnaire-2] as an introduction as a way to get patients to start completing the questionnaire, and depending on how they answer the questions, progress onto [Patient Health Questionnaire-9],” Shaal said. “But that’s only the start of it.”
The piece that pharmacists also need to consider in terms of their involvement in the mental health and SUD space is how to proceed upon the determination of a patient’s need for assistance in these areas, according to Shaal.
“Once the patient has answered the questionnaire, where does the pharmacist go from there? What kind of resources do they need to get patients into care and into therapy,” Shaal said.
Shaal noted there are several resources available for pharmacists to use for this purpose.
“So there is a provider locator tool, provided by SAMSA, and it’s one that can help us connect patients to care. There’s also many telehealth companies out there that are progressing and adding additional services for mental health,” Shaal said. “So, we can use these screening tools to fill that gap in care, provide the introduction into care, and help that patient from a local health care [setting].”
Additionally, Shaal noted that another valuable access point for patients in regard to easily completing screening questionnaires is through scheduling tools and medication management (MTM) services on pharmacy websites. However, Shaal noted that screening questionnaires are not the only option available to pharmacists for this type of intervention to fill gaps in care.
“So abandonment prevention is a major issue right now. We want to make sure that once patients are on therapy that they stay compliant and stay on therapy,” Shaal said. “So taking a look at abandonment prevention program—how can we outreach to patients at day 3 if they haven’t picked up their prescription or at day 7, and why haven’t they picked it up? Is it a cost consideration—do we need to look at co-pay assistance or foundation assistance? Is there anything we can do to lower the out-of-pocket costs for patients?”
Shaal noted that another issue that may lead to abandonment can be the adverse effects patients may be experiencing, which is another issue pharmacists can account for and consider steps to address.
“Maybe they’re just not on the right therapy at that moment in time—so we can make those recommendations and work with their health care provider and really get the patient on the correct product,” Shaal said.
Another issue that may lead to abandonment is transportation, which has some easy fixes for pharmacies, according to Shaal.
“Can we convert it over to a courier delivery or a mail service—so once again, meeting them where they are,” Shaal said.
Lastly, another cause of abandonment can purely be a lack of knowledge on the part of the patient, Shaal explained. Patients may not know exactly how the medication works and what those benefits may look like in the short and long term.
“The important thing [to remind them] is just because they’re feeling better, doesn’t mean they can stop the medication. So educating the patients and letting them know why they should continue the therapy [is important], and then we can help them along that way,” Shaal said. “This also goes into MTM services, as there are right now multiple different technologies that we can utilize to increase adherence for patients, especially when it comes to MTM.”
Shaal noted that the technologies available can be particularly useful for sending reminders, as well as electronic information and adherence information for their specific medications.
“Who better to provide to provide antidepressant medication management than a pharmacist,” Shaal said. “We can help our health care partners and health entities to jointly achieve success for these patients.”
Shaal E, Gainer K. Creative Solutions for Mental & Behavioral Health. Boston, MA: 2022 National Association of Chain Drug Stores Total Store Expo; August 29, 2022.