What I Wish I Knew - Recognizing Mental Health Struggles in Learners and Peers

Dr. Katie Tuck (Chamberlain), PharmD, BCPP, BCPS
Assistant Professor of Pharmacy Practice – Psychiatry
Regis University School of Pharmacy
Denver, CO

Dr. Tuck is an Assistant Professor of Pharmacy Practice at Regis University School of Pharmacy. Dr. Tuck received her PharmD from the University of Missouri Kansas City School of Pharmacy. She completed her PGY1 Pharmacy Practice Residency at the VA Eastern Colorado Health Care System in Denver, Colorado, and her PGY2 Psychiatric Pharmacy Residency at the South Texas VA in San Antonio, Texas. In addition to teaching mental-health and neurology-related topics at Regis University, she practices as a Clinical Psychiatric Pharmacist at a local inpatient psychiatric facility, where she precepts pharmacy students. Her goal as an educator is to encourage students to be compassionate as well as competent. She hopes to prepare students to be empathetic and passionate in their care for patients by modeling this care and by demonstrating care of the whole patient.

Intro

If you are reading this, you likely have specific training in mental health or a specific interest in psychiatric pharmacy. As such, I imagine that your ability to detect mental health struggles and address those struggles is well above average. However, it can be easy to forget to check in on the wellbeing of our learners and peers while managing our own stressors.

What types of mental health struggles are learners facing today?

Recent studies suggest increased rates of anxiety and depression in our post-pandemic era graduate students.¹ This shift has resulted in a subsequent increase the in educational and family distress of learners, and has shown to be negatively correlated with students’ academic self-perception^2,3. Other harmful impacts of mental illness on pharmacy learners include suicidal ideation, smoking, substance misuse, and unhealthy eating habits. These statistics may not come as a surprise, as we all remember the stressful days of being a learner.

What are steps to take when approaching learners’ mental health struggles?

1. Learn the common warning signs of distress among your learners. While some learners feel comfortable reaching out about their mental health struggles, there are many who do not. These learners often suffer in silence. For them, it is important to be able to identify changes from baseline that may indicate distress. Changes in baseline could include new professionalism concerns, such as a learner who suddenly presents with a pattern of tardiness. Another important change in baseline for learners could be a change in their academic performance. For example, a student who is a strong learner suddenly starts failing assessments. Identification of more subtle changes from baseline may require a better understanding of the learner’s baseline behaviors and personality traits. Therefore, it is important to establish frequent “check-ins” with students to make sure shifts in behavior may be identified. Keep an eye out for new or worsened difficulties concentrating, signs of exhaustion, and isolation.
2. Directly address concerns with the learner in a safe and non-judgmental manner. If there are new concerns about a learner’s mental health, the ideal course of action is swift, non-judgmental confrontation and provision of support and resources. Depending on your relationship with the learner, it may be appropriate to speak with them directly. In scenarios where there is someone better suited to have the conversation with the learner, such as their residency program director or a supervisory mentor, that person should be notified promptly about your concerns. Though discussions about wellbeing may be difficult, the best strategy is to openly ask the learner how they are doing and listen non-judgmentally. It is important to remind the learner of your requirements for reporting at the beginning of the conversation to ensure there is a mutual trust and understanding of your specific role. If the learner feels comfortable disclosing personal information, respond supportively, and offer further assistance if needed.
3. Share available resources. Your professional relationship may prevent a learner from disclosing their mental health struggles. However, if you familiarize yourself with your institution’s supports and provide resources on those supports to learners who are struggling, you can nudge students into getting the help they need. Examples of resources that can be shared could include student counseling services (which are often included in tuition), numbers for local support groups or national hotlines, information regarding residency advisory or wellness committees, and many more. It is important to distinguish provision of resources from provision of care. While sharing information about resources and assistance in finding suitable treatment is appropriate, directly providing any mental health treatment is not appropriate. For example, it would be appropriate as a mentor to recommend resources to work on distress tolerance and coping skills (such as mindfulness applications or books) as these are resources available to everyone and do not include you coming up with a treatment plan with the learner. However, it would not be appropriate to recommend the learner undergo DBT or provide DBT directly to the learner, as this could be interpreted as a patient-provider relationship. Another example of this difference is questions about medication regimens. Specifically, learners may ask if they should increase their dose of medication or ask for recommendations as to which medications to start. It is not within the scope as a clinical faculty member to make these recommendations, although we can help them find access to a provider who can discuss these questions with them.

How can I approach this topic with peers?

Broaching this topic with peers can often be more challenging. However, I recommend a similar strategy as described above. The first step is identifying any changes in baseline in your peer that may indicate distress. Depending on the relationship with your peers and your familiarity with baseline behavior, this may be easier to do than with learners. In addition to some of the signs discussed regarding learners, there may be other telling signs in colleagues like an increase in substance use. If a concern for their mental health is identified, the second step would again be to address the concerns directly and nonjudgmentally with the peer. Again, the approach to this is dependent upon your relationship and your concerns, but you may consider involving someone who works more closely with this peer. Lastly, the peer should be provided with support and resources. Given the complexities of workplace relationships, ensuring your peer that you can be private and trustworthy is particularly important.

How can I establish a culture of wellness within pharmacy schools, residency programs, and workplaces?

I would stress the importance of establishing a culture of wellbeing and minimizing cultural stigma against mental health. This is an ongoing effort and requires buy-in from peers, administration, and learners collectively. Though you alone cannot establish the culture at your facility, you can encourage healthy habits by setting examples of wellbeing, providing a positive environment, and discussing personal wellness and mental health openly in non-judgmental ways. There are many ways to accomplish these goals, but these are some of the things that I have implemented at my school of pharmacy to promote a culture of kindness, wellness, and support.

• Encourage breathing exercises and periodically doing short, guided breathing exercises as a group before exams or difficult meetings.
• Organize “Wellness Walks” for faculty, staff, and students over lunch breaks.
• Speak openly and kindly about mental health. This includes encouraging non-stigmatizing language in the curriculum and organizational discussions (e.g.., “death by suicide” versus “commit suicide” or “people with substance use disorders” versus “addicts”).
• Staying up to date on campus, local, and national events that may be triggering. A simple statement of support for communities impacted by tragedy and trauma can be all a student needs to feel supported.