The Impact of Implementing a Mental Health-Focused Elective for Pharmacy Students

Within required pharmacy school curricula, focus is placed on educating students on the most common disorders and medications that may be encountered within patient care settings. A published review describing pharmacy curricula focused on psychiatry and neurology reported that programs dedicate the most didactic time (between 3 to 5+ hours) toward learning about epilepsy, depression, schizophrenia, substance use disorders, and pain. Disorders such as autism, personality, and eating disorders were either not taught or given less than one hour. Required integrated pharmacotherapy courses are often very fast-paced with emphasis placed on pharmacology and clinical use of psychiatric and neurologic medications. There is limited time left to focus on the patients’ lived experiences, non-pharmacological treatment options, and barriers to care such as stigma. A mental health elective is an opportunity for faculty to capture this content with more flexibility, creativity, and autonomy.

There have been several articles published describing the positive impact of mental health-focused electives on students' perceptions, social distance, and stigmatizing views of mental illnesses. Improvements have also been noted in confidence and willingness to initiate conversations on mental health. In this article, I will briefly describe an elective that we have taught at SIUE School of Pharmacy for the past 15 years, including personal student feedback on their experiences taking the course.

The elective was designed to be discussion-based, with a smaller cohort of students. Since its inception in 2007, it has remained a 2-credit hour course, with a maximum capacity of 30 students. Limiting the number of students allows for the creation of a safer, more manageable environment, promoting more thoughtful and empathic conversations. Over the years, documentaries surrounding the impact of serious mental illness on family and loved ones, understanding suicidality, and overdose prevention have been incorporated into the class. Students are routinely given opportunities to engage in discussion and practice skills, such as administering the AIMS, suicide risk assessment, and how to provide harm reduction education. Topics that are consistently covered every year include:

• The value of involvement in mental health advocacy organizations (including AAPP and NAMI)
• The use of person-first language
• Understanding the DSM-5-TR and mental status exam
• Patients’ experience with psychosis, with discussion on antipsychotic medication selection
• Suicide assessment and prevention
• Depression assessment and antidepressant medication selection
• Substance use disorders and harm reduction, including patients’ lived experiences
• Practice administering the most common clinically used psychiatric rating scales
• Personality disorders, understanding through case reflection
• Inpatient vs outpatient psychiatric practice settings
• Crisis intervention and trauma-informed care

The second week of class involves a more in-depth discussion on Motivational Interviewing, with opportunities to practice conducting a psychiatric patient interview. This is meant to prepare the students for a required patient interview experience that occurs in waves throughout the semester. Students are tasked with performing a psychiatric patient interview (formerly in person, and now via telehealth due to pandemic restrictions). Following the interview, the student must prepare a thorough psychiatry SOAP note, including subjective information taken from the interview, objective information obtained from the patient chart, as well as a complete mental status examination. This exercise continues to be the most influential and impactful student learning experience in the class.

Student feedback surrounding this course has remained positive through the years, and the following comments represent personal reflections on its impact:

The classroom experience:

• “I truly loved this class, and I love how safe the space was to come into every Thursday.”
• “The in-class interactive activities that were discussion-based were amazing, eye-opening, and respectful.”
• “It was more of a discussion-based class, so it was helpful to be able to express concerns or thoughts when talking about conditions that are taboo in the general public.”
• “I loved the role play! It can be so hard to instill empathy and understanding in students with regard to mental illnesses and role-playing can help with that.”

The patient interview experience:

• “One of my favorite experiences during this class was getting to sit in on a patient interview. This interview helps to give us real life experience and give some of these disorders a face instead of just words on a PowerPoint slide, which is pretty much invaluable.”
• “The patient interview was a really powerful experience and it helped me feel more comfortable in the mental health setting.”
• “The patient interview was incredibly eye-opening. That was an experience that I will remember for the rest of my life.”
• “To hear a person with a mental illness openly talk about their struggles was very interesting and gave me a completely new perspective.”

Overall impact:

• “This elective is amazing and has opened my eyes to the need for pharmacists that specialize in mental health.”
• “I feel much more comfortable/confident working with/making treatment plans for patients with mental illnesses.”
• “I believe every health care provider should have to take a mental health course similar to this to further their practice. This course positively changed the way I view mental health. I feel much more comfortable when thinking about helping an individual with a mental health disorder.”

Since the creation of this elective course, it continues to be one of my most joyful experiences in academia. I have learned that giving students the space and opportunity to further explore their own biases and beliefs surrounding mental health disorders and empowering them to be a part of the positive change we hope to see within behavioral health care, can have a profound impact on both the student and the instructor. While most students may not aspire to specialize in psychiatric pharmacy, all students will likely have some influence on the provision of patient care. An elective course such as this can inspire future pharmacists to approach patient care with more empathy and understanding, and equip them with the tools and confidence to routinely incorporate mental health care into holistic conversations about overall health and wellness.

References

1. Dopheide JA, Bostwick JR, Goldstone LW, Thomas K, Nemire R, Gable KN, Cates M, Caballero J, Smith T, Bainbridge J. Curriculum in Psychiatry and Neurology for Pharmacy Programs. Am J Pharm Edu. 2017,81(7)5925.
2. Gable KN, Muhlstadt KL, Celio MA. A mental health elective to improve pharmacy students' perspectives on mental illness. Am J Pharm Educ. 2011;75(2):34.
3. Robinson JD, Maslo TE, McKeirnan KC, Kim AP, Brand-Eubanks DC. The impact of a mental health course elective on student pharmacist attitudes. Currents in Pharmacy Teaching and Learning. 2020,12(7).
4. Cates, M.E., Neace, A.L. & Woolley, T.W. Pharmacy students’ attitudes toward mental illness at the beginning and end of the professional curriculum. Currents in Pharmacy Teaching and Learning. 2012, 4(2).
5. Dipaula, B.A., Qian, J., Mehdizadegan, N. & Simoni- Wastila, L. An elective psychiatric course to reduce pharmacy students’ social distance toward people with severe mental illness. Am J Pharm Edu. 2011, 75(4).
6. McGuire, J.M., Bynum, L.A. & Wright, E. The effect of an elective psychiatry course on pharmacy student empathy. Currents in Pharmacy Teaching and Learning. 2016, 8(4).