U.S. suicide rates have increased dramatically in the last two decades — almost 30 percent, according to a recent report from the Centers for Disease Control and Prevention. In 2016, 45,000 Americans died by suicide, making it the 10th leading cause of death. According to Casey Gallimore, PharmD, an associate professor at the University of Wisconsin-Madison (UW-Madison) School of Pharmacy, pharmacists are in a unique position to intervene with patients at risk of suicide. Yet, because most state pharmacy boards don’t mandate suicide prevention training, many are unprepared to do so.
In the current medical landscape, people face daunting barriers to receiving healthcare: appointments, waiting lists, costs, and insurance requirements. However, those obstacles don’t apply to pharmacists to the same extent, says Gallimore. Often a patient can simply walk into a community pharmacy and talk to the pharmacist. These practitioners may see patients monthly or even more often, which makes them uniquely suited to identify patients at risk of suicide and intervene, Gallimore says.
Still, as of August 2017, only one state — Washington — required pharmacists to complete suicide prevention training. And the requirement is only to complete a one-time, three-hour course. This nationwide gap in training leaves pharmacists in a position from which they could help, but without the tools to do so.
“Pharmacists understand the importance of screening and talking with patients about suicide, but without proper training, that is a really intimidating task for anyone,” says Gallimore. Additionally, these professionals are often isolated in environments like community pharmacies where there’s not easy access to other healthcare professionals who may have more education in this area.
Even without state board requirements, some pharmacists might choose to seek out training on their own. But this too can be difficult. A survey of pharmacist-focused suicide prevention training published in the Journal of the American Pharmacists Association identified only 12 such programs in the United States that concentrated specifically on pharmacists. Of those, only six were in-person.
Pharmacy schools are in an ideal position to remedy this lack of suicide prevention training. And regardless of whether a state mandates this type of education, Jennifer Stuber, PhD, an associate professor at the University of Washington School of Social Work and center director for Forefront Suicide Prevention, believes schools should still include a focus on suicide prevention in their curricula.
“These are life-saving skills that all health professionals need to know,” she says. Stuber believes every pharmacist should have the skills to look for suicide warning signs; safely store and dispose of medications; empathize with and listen to patients; ask about suicide; remove dangers, including medications; and pursue next steps to get help.
At UW-Madison, three pharmacy students took suicide prevention training into their own hands with the help of Gallimore. Meredith Frey, Marnie Janson, and Eric Friestrom collaborated with the Wisconsin Society of Pharmacy Students and the Psych and Neuro Special Interest group to create a stand-alone, on-campus training program using the Question, Persuade, Refer (QPR) framework created by the QPR Institute. This framework, which the QPR Institute equates to CPR, teaches people “how to recognize the warning signs of a suicide crisis and how to question, persuade, and refer someone to help,” according to the organization’s website.
Gallimore says intervention trainings like the one Frey, Janson, and Friestrom designed are a great step forward. They are also easily replicable at other universities that may be interested in creating their own.
In the long term, though, Gallimore believes it’s important that pharmacy schools adopt more rigorous instruction in line with Stuber’s recommendations, including simulation and competency assessment. “I think [suicide prevention training] is a wonderful opportunity for interprofessional education and for pharmacy programs to engage with and learn from instructors and students in other health professions that are more extensively training in [this area],” Gallimore says.
At the Université de Montréal, Philippe Vincent and Pierre-Marie David, PharmD, both pharmacy professors, designed and implemented such a program for third-year pharmacy students. It guides students to examine their own beliefs about suicide, understand the psychology of it and how to intervene appropriately, and become aware of local mental health resources. Students were provided with information and then asked to role-play two scenarios. They also learned strategies for evaluating suicide risk.
Vincent and David’s findings, reported in their article “Suicide prevention in pharmaceutical education: Raising awareness with inspiring stories” in The Mental Health Clinician, were promising. At the end of the course, participants’ knowledge was evaluated via formal exams. Eighty percent of the class was successful. Students also completed a survey regarding their attitudes about suicide before and after the training. Previously, when asked whether they totally agreed, agreed, or were undecided about the statement “It is a human duty to try to stop someone from committing suicide,” 28 percent of the participants indicated total agreement. After the training, that number jumped to 65 percent.
Vincent and David emphasized in their article that they believe training programs such as theirs are both important and possible with relatively few resources. These programs also create noticeable change.
More than 63,000 students enrolled in U.S. pharmacy schools in the fall of 2017. If these institutions adopted suicide prevention training as an integral part of their curricula, these future practitioners could become a strong first line of support for patients at risk of suicide.
Gallimore argues, however, that pharmacists are in such a unique position to prevent suicide that their participation shouldn’t be thought of so much as an opportunity as an obligation.
“I believe it is the responsibility of the pharmacy profession,” she says, “to actively participate in suicide prevention efforts as part of the wider healthcare team.”●
Alice Pettway is a contributing writer for INSIGHT Into Diversity. This article was published in our January/February 2019 issue.