MENTAL HEALTH Making Headway
Whilst not directly involved in the diagnosis of mental health conditions, pharmacists are key players in the aftercare of patients who are diagnosed with, and receiving treatment for, such conditions.
O
f course, it isn’t possible to possess a high level of expertise in each and every
one of the plethora of illnesses which exist, but pharmacists should be aware of the common types and their treatment, so that they can factor this into their counseling and patient- centered advice, in addition to further support which may significantly assist their patients.
Northern Ireland’s mental health One of the major issues surrounding mental health is the fact that it is such a taboo subject – in fact, recent research has found that it is the strongest taboo, with the admission of having a mental health disorder being associated with major difficulties at work, and causing problems within relationships(1)
. Such a stigma
produces a number of problems, with people being less likely to seek help from a professional, or speak about it with their friends or family, no matter how close they may be. This can mean that it is especially difficult for statistics on such conditions to be assessed, preventing the full extent of the issue being ascertained.
So, with this in mind, how big is the problem in Northern Ireland at the moment? Well, the simple answer is that it’s a massive problem, and that’s before we consider the underestimated nature of the numbers due to the points above. According to the 2013-2014 Northern Ireland Health Survey, 19% of people had signs of mental health issues, with 45% of females and 29% of males taking medication for stress, anxiety or depression at time of questioning. These numbers become even more serious, and highlight the disparity between the sexes, when the number of suicides in 2014 are reported – there were 268 in total, with 75% of these being men(2)
.
There is no doubt that these numbers are very unsettling, but there may be some light at the end of the tunnel. According to the Northern Ireland Executive, the number of hospitalisations due to mental health issues has decreased by 13.3% over the last five years, with the number of inpatient admissions falling by a similar amount, and admissions for day case treatment falling by almost a third(3)
.
This is an encouraging finding, which suggests that efforts into removing the
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Anxiety According to Refine NI, anxiety can be defined as “an unpleasant feeling when you feel worried, uneasy or distressed about something that may or may not be about to happen” (4)
.
Of course, these are feelings not alien to any of us, and from time to time, we can all expect to be nervous or worried about life events or otherwise. This means that the diagnosis of a condition such as anxiety can be particularly difficult. However, if feelings of anxiety become prolonged
taboo of mental health conditions, in addition to the encouragement of patients to speak out about their issues, is working – at least to a certain extent. However, there is no question that the numbers of people suffering with these conditions is still too high, and as a result, more needs to be done to ensure that these patients receive the treatment and care that they need, when they need it. Moreover, it is apparent that current actions being taken are assisting women more than they are men, and more work needs to be done to assist males to recover from their mental ailments.
As a pharmacist, you may now be thinking about what you can do to help your patients who are suffering from poor mental health. In reality, there is no perfect formula for this, due to the multifactorial nature of mental health care, and the individuality of this category of condition. However, one way which pharmacists can assist their patients is by improving the scope of their knowledge about these conditions, and the associated treatments. This knowledge, and its provision to your patients, may alleviate their trepidation towards taking medications, or using other treatment strategies, leading to an overall reduction in their symptoms, rather than leading to their exacerbation.
As always, it’s not possible to cover the full range of mental health conditions within the confines of this article. However, it should act as a starting point, touching on conditions which you may encounter more commonly, and will hopefully act as a springboard for you to go out and learn more about this important, and undoubtedly interesting area of healthcare.
or begin to affect the patient’s day-to- day life, help and treatment should be sought. In terms of specific symptoms which may be experienced, some more common sensations are detailed in Box 1.
Box 1. Examples of presenting symptoms in anxiety
Physical Symptoms • Nausea • Muscle tension and headache • Pins and needles in extremities • Increased breathing rate • Irregular heart beat • Change in toilet habits
Psychological Symptoms • Nervousness • Sense of dread • Restlessness • Lack of concentration • Numbness to external stimuli • Lack of sleep
Obviously, living with any of these symptoms is undesirable, but when long-term effects of anxiety are also considered, the full seriousness of such a condition can be realised. For example, depression, long-term insomnia, and even immunocompromisation can all occur in patients suffering from anxiety(5)
.
In terms of the management of such a condition, NICE have provided relatively complex guidance which recommends a stepped-care approach. Indeed, this approach also factors in the different needs of patients at different stages of anxiety, and the interventions that are required during each situational combination. As a result, the recommendations, and treatment strategies cannot be detailed here, but pharmacists are encouraged to include this guidance as part of their learning within this topic, so that they can learn more about the stages of anxiety, and the management, both pharmacological
and otherwise. This information can be found at
https://www.nice.org.uk/guidance/cg113.
Mild depression Mild depression, otherwise known as dysthymia, is a chronic state of low mood, which may involve less serious symptoms than major depression, or a smaller amount of symptoms normally associated with the more serious form of the condition. Indeed, in some cases, the symptoms can be mild enough for patients to not realise that they have a mental health issue, and can even feel that they are a “fraud” if they are diagnosed with the condition.
Overall, this condition presents itself as a low or sad mood, which persists for most days over a period of two or more years. In addition to this main symptom, patients can also experience(6)
:
• A negative view of themselves, others or of life events • The feeling that problems are unsolvable • A feeling of increased hardship • Tiredness • Lack of concentration
Whilst seeming to be a less serious form of depression than other types of depression that you may of heard of, dysthymia should under no circumstances be underestimated, as it can lead to the occurrence of more serious forms of the condition, and can also significantly reduce the quality of life of the sufferer. As a result, it is important that dysthymia be treated with the same degree of urgency and understanding as other conditions, to prevent worsening of the situation.
Again, NICE have published guidance on treatments for mild to moderate depressive illnesses, with the initial treatments for these conditions being based around various psychological or physiological treatments (Box 2).
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