This study aimed to quantitatively describe the pharmacist’s role in providing mental health services in Jordan, through assessing discrepancies between pharmacists’ attitudes and current practices. Jordan is considered a LMIC with 64 mental health outpatient facilities and four mental hospitals established until 2012 [22]. However, there is a lack of mental health training for primary health care workers and interactions between the primary care and mental health systems are rare [22]. Pharmacists in Jordan are well-trained health care providers, with two bachelor programs (BPharm and PharmD) are found in Jordanian universities besides postgraduate programs (MSc and Ph.D.)[23]. Thus, we hypothesized that pharmacists in Jordan hold the potential to provide care to mental health patients.
Statement of key findings
Among seven other mental health conditions captured (anxiety, attention deficit hyperactivity disorder, eating disorders, addiction, post-partum depression, obsessive-compulsive disorder, schizophrenia), depression was reported as the most prevalent condition in Jordan, for which pharmacists provide pharmaceutical care services. Typically, this is seen in LMICs and can be explained by different factors like economic difficulties and the low socioeconomic status of the LMIC population[16]. In contrast, in industrial countries, anxiety seems to be the most prevalent mental disorder [24].
In our study, we showed that most pharmacists recruited in this study, 89% on average, endorsed a positive attitude toward their potential role in mental health care. Given this estimate, they perceive their role as more important than they practice in the real world. More than two-thirds of the included pharmacists were highly motivated; their willingness was to cover long-term follow-up medication adherence while most pharmacists (approximately 97%) were at least agreed to advise patients to consult a doctor when symptoms worsen or when the pharmacist recognizes symptoms.
The highest discrepancy in scores was observed in some items between pharmacists’ attitudes and their current practice. This was when 70.8% of pharmacists strongly agreed on providing long-term follow-up medication adherence to mental health patients, and the same pharmacists saw that this initiative is away from the reality and few or no patients are provided long-term follow-up, same with the item of long-term follow-up symptoms and side effects. Same perspective was noticed with other two studies which underscore how the ongoing follow-up of antidepressant treatment adherence monitoring is still unmet in pharmacists’ daily practice [25], [26]. On the other hand, most pharmacists showed relatively lower discrepancy scores between their attitudes and practice when they were asked about providing support to their patients, advising their patients to consult doctors whether when the pharmacist recognizes symptoms or when symptoms worsen.
In Jordan, pharmacists believe that cooperation with psychiatrists is more important than cooperation with other health care providers. However, in practice, most pharmacists and partners share information about individual patients. Also, cooperation at different levels (receiving, sharing, or discussing information) is frequently seen between pharmacist and their colleagues. In Jordan, cooperation between pharmacists and psychologists, community health care services, and health insurance companies are lacking. This could be explained by different reasons like the low number of psychologists in Jordan [22], cultural sensitivity toward visiting psychologists, limited number of community health care facilities [27].
All responding pharmacists in Jordan perceived a lack of education in mental health issues as the most challenging barrier to providing care for patients with mental health. This was consistently seen in the literature [28], [29] and it was shown in our study that the high discrepancy in the scores between the attitude of pharmacists to provide long-term follow-up for symptoms, treatment side effects, and the current practice is due to lack of education programs. If pharmacists receive training on mental health issues and treatment, they can be involved more in the eleven roles evaluated in our study starting from maintaining a trusting relationship to advise when symptoms get worse. Pharmacists in Jordan also showed their need for some privacy in community pharmacies to discuss personal issues with their patients. The social stigma was perceived as the third barrier and this can be resolved by psychological awareness campaigns [27].
Nearly half of pharmacists made it clear that the unusual collaboration with other partners (patients or providers) and difficulty to get information from partners are considered the most challenging barriers for them to get involved in mental health care. The lack of collaboration between pharmacists and partners was observed by Scheerder et al. [21]. Different mechanisms were suggested to increase pharmacist-partner collaboration like treatment pathways utilizing a multidisciplinary team as per Locke et al.[30]. However, as a caution, any attempt to increase pharmacist-partner collaboration must need to consider the issue of patient confidentiality.
Strengths and weaknesses
This study, for the first time, provides an insight about a new role of pharmacists in the care of patients with mental health problems in a fair number of pharmacists in different settings. Our study has limitations. The cross-sectional nature of the study hinders us from withdrawing and cause-effect or temporal relationship between variables. Survey responses were online and self-reported; recruited pharmacists may have been biased toward the topic of depression; while the sample size of participating pharmacists is sufficient, the results of this study are limited to Jordanian settings, and therefore results cannot be generalizable to other countries. The results of this study can be considered exploratory and further research is needed to reveal the association between variables.
Interpretation
This study, for the first time, provides an insight about a new role of pharmacists in the care of patients with mental health problems in Jordan. Although Jordanian pharmacists endorsed a positive attitude toward their potential role in mental health care, their actual practice is not a reflection of this willingness. Pharmacists to be more involved in the care of patients with mental health. More active collaboration with other healthcare providers such as psychiatrics and psychologists. Pharmacists should receive further education and training in the mental health issues, and pharmacies should be redesigned to offer a private area for counseling of patients with mental health issues.
Future research
Future research should assess the effect the implementation of training and education in mental health issues on the actual clinical pharmacy practice within this scope. Also, the quality of mental health services provided by pharmacists as perceived by mental health patients and psychiatrics should be evaluated.