By: Courtney Humphries and Lori Armistead
Mental illnesses – such as depression and anxiety – have been on the rise in the United States for decades. During the COVID-19 pandemic, maintaining mental health became even more challenging for a lot of people, with reported rates of depression and anxiety four times higher than in 2019, as shown in Table 1. The effect of the pandemic on adolescents resulted in higher rates of mental illness, substance use, and suicidal thoughts as compared to adults.1 In addition, the pandemic impacted the mental health of women and those with chronic medical conditions more significantly than that of their counterparts.2 The struggles that many Americans are facing have catapulted mental health into the much-needed spotlight. Dialogue has expanded on how to best combat these increasingly common public health issues and facilitate greater access to mental health care.
Table 1. Impact of COVID-19 pandemic on reported symptoms of depression and anxiety1
When thinking of places to seek care for their mental health challenges, people may first think about reaching out to their primary care doctor or a mental health counselor. However, due to an increased demand for these professionals combined with decreased capacity through provider attrition, getting prompt care when needed most can be a big challenge.3 To mitigate these access barriers, some community pharmacies have started offering behavioral health screenings – specifically for depression and anxiety – to help identify patients in need of resources and to connect them with other providers and resources. These pharmacies are also providing educational counseling in addition to behavioral health screenings and referrals.4
In an effort to increase access to behavioral health care, the Community-based Value Care Initiative (CVCI) project has implemented a two-pronged behavioral health patient care intervention which includes a screening and referral program and a 6-month education and medication management program. The goals of these programs include:
- Screening and Referral Program: To identify patients with untreated or undertreated depression and/or anxiety and refer them to appropriate care
- Full Behavioral Health Program: To optimize treatment for depression and anxiety through provision of evidence-based medication management and health education
As part of the CVCI project, we are working with several pharmacies to advance access to behavioral health care in community pharmacy settings and to better serve patients and communities. Through the Behavioral Health Screening and Referral Program, community pharmacies are providing depression (PHQ-9) and anxiety (GAD-7) screenings to patients 18 and older. These screenings are integrated into current patient care workflows by utilizing community health workers, technicians, pharmacy students, pharmacy residents, and pharmacists.
A total of 7 community pharmacy sites representing four pharmacy organizations are providing the Screening and Referral Program. The goal of these pharmacies is to identify patients in need of care and connect them with local primary care providers, specialists, counselors, and suicide prevention resources. As part of the program, patients will receive education on anxiety and/or depression if they screen as potentially at-risk. This education is brief and focuses on what the disease state is, what the symptoms are, and how is it treated. Patient recruitment began in November 2022 and continued through May 2023.
One pharmacy organization is also providing the full Behavioral Health Program for patients diagnosed with anxiety and/or depression in addition to the Screening and Referral Program. As part of this program, each patient receives a total of six behavioral health (BH) education sessions from the pharmacist. Of those patients currently taking anxiolytics and/or antidepressants, they will also receive behavioral health medication management. The topics of each monthly medication management and educational session are listed in Figure 1.
Additionally, to provide the full Behavioral Health Program, this pharmacy organization is also screening patients for select social determinants of health (SDOHs) during patients’ initial, third, and final sessions. For identified unmet SDOH need(s), the pharmacy team informs the patient about available, local resources and/or connects them with appropriate professionals to assist in addressing their need(s). Currently the pharmacy has community health workers who are comfortable discussing unmet SDOH needs for their Medicaid patients and are working to expand to all their patients as part of this intervention. Utilizing this additional pharmacy team member will assist the pharmacy with expansion of additional services.
Community pharmacies can offer expanded access points for patients to receive care from a trusted provider. The CVCI project aims to leverage this accessibility and trust to help address the public health need for greater behavioral health care access. There are multiple resources and organizations who provide information for patients on behavioral health with some listed below.
National Organizations and Resources
- 988 Suicide & Crisis Lifeline: Dail 988 (multiple languages) or text 988 (English only)
National 3-digit sucide prevention, mental health, and substance use crisis hotline
- National Suicide Prevention LIfeline: 1-800-273-TALK (8255)Toll-free lifeline to be connnected with a trained counselor at a crisis center anytime.
- Crisis Text Line: Text HOME to 741-741
Connect to a crisis counselor anywhere in the U.S. 24/7, confidential and free.
- American Academy of Child and Adolescent Psychiatry (AACAP) Depression Resource Center: Consumer-friendly definitions, FAQs, clinical resources, and videos
- #BeThe1To The 5 Steps: National movement that provides 5 action steps for communicating with someone who may be suicidal. Additional stories, tips, and resources available. Home – #BeThe1To
- National Alliance on Mental Illness (NAMI): A mental health organization with information on signs and symptoms, various conditions, and treatments. Home | NAMI: National Alliance on Mental Illness
- National Institute of Mental Health (NIMH): The main federal agency on mental disorder. Site includes information on mental health disease states, statistics, brochures and fact sheets, clinical trails, and free education. NIMH » Home (nih.gov)
- Mental Health First Aid: training course to provide skills to help someone with a mental health problem or a mental health crisis
- 2-1-1 Get Connected, Get Help: Call 2-1-1 from anywhere
Comprehensive source of information about local recourses and services
Courtney Humphries, PharmD is a Community Pharmacy Consultant for the UNC Eshelman School of Pharmacy. Lori Armistead, PharmD is a senior research associate.
- DeAngelis, T. (2021, November 1). By the Numbers: Depression and anxiety escalate during COVID. Monitor on Psychology. Retrieved October 3, 2022, from https://www.apa.org/monitor/2021/11/numbers-depression-anxiety
- World Health Organization. (2022, March 2). Covid-19 pandemic triggers 25% increase in prevalence of anxiety and depression worldwide. World Health Organization. Retrieved October 3, 2022, from https://www.who.int/news/item/02-03-2022-covid-19-pandemic-triggers-25-increase-in-prevalence-of-anxiety-and-depression-worldwide
- Demand for mental health and addiction services increasing as COVID-19 pandemic continues to threaten availability of treatment options. National Council for Mental Wellbeing. (2020, September 9). Retrieved October 3, 2022, from https://www.thenationalcouncil.org/news/demand-for-mental-health-and-addiction-services-increasing-as-covid-19-pandemic-continues-to-threaten-availability-of-treatment-options/
- Caron, C. (2021, May 7). Therapy on aisle 7: Retailers are entering the mental health market. The New York Times. Retrieved October 3, 2022, from https://www.nytimes.com/2021/05/07/well/therapy-pharmacy.html