Devon A. Sherwood, PharmD, BCPP (left)
Assistant Professor of Pharmacy Practice
University of New England, College of Pharmacy
CPNP Student Committee Member
Suzanne C. Harris, PharmD, BCPP (right)
Clinical Assistant Professor/UNC Hospitals Region Experiential Director/Clinical Pharmacist Practitioner
UNC Eshelman School of Pharmacy
CPNP Student Committee Member
Stigma towards mental illness has occurred for centuries. Despite major improvements in psychiatric care over the last several decades, pharmacists and other healthcare providers are less comfortable providing services for psychiatric conditions compared to other illnesses. This is especially concerning given that about one in five adults in the United States is living with a mental illness, and psychotropic medications account for nearly 20% of the most common medications dispensed in pharmacies.
The issue calls to question whether the education healthcare providers receive as students addresses stigma and the barriers it creates for patients. Those of us who are faculty members, regularly observe students’ discomfort toward treating patients with mental illness. We decided to take a closer look to observe whether psychiatric coursework or involvement in student organizations focused on mental health affects student stigma and if these interventions can improve student perceptions. These investigations were successful due to student involvement not only as participants but as contributors to the planning and execution of the design.
Survey of Student Stigma Before and After Core Didactic Psychiatry Coursework
In an effort to better understand pharmacy student stigma toward mental illness and how it compares to other healthcare professions, a study was developed at the University of New England in Portland, Maine. The first phase involved anonymously surveying three health profession programs (pharmacy, nursing, and social work) using the Opening Minds Stigma Scale for Healthcare Providers (OMS-HC) both before and after core didactic psychiatry coursework. The impact of coursework was not statistically significant as all programs yielded similar results with no remarkable score change.
Survey of Student Stigma Before and After a Focused Psychiatry Elective
After learning psychiatry coursework does not appear to alter student stigma, the next phase of the UNE study evaluated if interventions in the classroom environment could improve student perceptions. A pharmacy elective course was designed to address stigma and proper treatment of psychiatric patients. This elective was the first pharmacy course recorded in the United States to include Mental Health First Aid USA certification. This 8-hour program provided training to assist someone experiencing a mental health crisis, educated about risk factors and warning signs for mental health and addiction concerns, and where to turn for help. Various methods to “humanize” mental illness were used including bringing in a panel of speakers from the NAMI to discuss their journey living with a mental illness, leading an autobiography book review by a woman diagnosed with schizophrenia, reviewing the neurobiology that causes psychiatric illness, and holding focused topic reviews on primary psychiatric disorders. Results observed were remarkable with all 20 pharmacy students demonstrating significant improvement in reduced stigma toward mental illness. These findings were obtained by the UNE faculty member and two pharmacy students completing independent study research and were presented at the 2016 CPNP Annual meeting and are currently being prepared for publication.
Student Engagement and Perceptions of Stigmatizing Views in a Mental Health-Focused Collegiate Organization
The CPNP chapter at UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina, worked collaboratively as a student research team to design, promote, and execute a study as one of the goals of the 2015-2016 collegiate chapter. Knowing that stigma was also an area of focus outlined by the CPNP Foundation for student projects, the student leadership and the faculty advisor chose to pursue this topic, with a focus on student perceptions towards patients with mental illness. The research team involved students in different years in the pharmacy curriculum. While all were involved with the overall process, students divided into smaller groups to focus on specific tasks based on their individual strengths and interests: 1) literature review for projects related to stigma, 2) consultations with faculty experts in educational research for survey development, and 3) completion of the IRB application respective to their work. All contributed equitably to the data collection, data analysis, abstract submission, and poster development.
The study evaluated the extent that participation in student organizations focused on mental health, influenced attitudes towards patients suffering from mental illness. This study also assessed students’ plans to pursue additional educational opportunities in psychiatric pharmacy. Data was collected as an anonymous, voluntary survey open to all 2015-2016 student CPNP chapters. Stigma sections of the survey were an adaptation of previously validated instruments assessing stigmatizing beliefs. Observed results suggest the extent of involvement (i.e., number of activities) was unrelated to level of stigma. However, some activities such as leadership roles had higher level of impact on student perceptions and were associated with lower stigma scores. Additional outreach experiences and neuropsychiatric APPEs were reported as the most likely to be pursued. These findings obtained by the UNC faculty member and three pharmacy students involved in the study were presented at the 2016 CPNP Annual Meeting and are currently being prepared for publication.
Statements of reflection from the research team included, “It was a rewarding process that I feel will better prepare me for the residency research process” and “Addressing stigma in pharmacy students is important because we are in a profession that treats all patients, including those suffering from a mental illness.”
While often unintentional, pharmacy students have been previously described as prone to stigma and discomfort when interacting with patients with mental disorders. Our findings are similar to previous studies evaluating other healthcare professionals and students indicating students carry stigma toward persons with mental illness. These are just a few examples of how engaging students through focused electives or other activities beyond the didactic curriculum have the potential to address the social distance and stigma toward patients with mental illness.