2024 Pharmacy Forecast: A Focus on Mental Health
Mental health challenges in the United States were exacerbated by the COVID-19 pandemic, and pharmacists are poised to help pick up the pieces.
For more than a decade, the American Society of Health-System Pharmacists (ASHP) and the ASHP Foundation have released a forecast surveying pharmacy leaders from around the United States on key themes and trends influencing health systems and, ultimately, pharmacy practice at large. The Pharmacy Forecast discusses a broad range of topics and aims to provoke thoughtful discussion on issues impacting patient care, population health, and the pharmacy profession as a whole.
Two minds representing differences in mental health / melita - stock.adobe.com
This year, the Pharmacy Forecast identified 6 themes for the survey that directly relate to pharmacy services within the community: public health priorities, the mental health crisis, care equity, new disease paradigms and treatment innovations, artificial intelligence, and crisis and opportunity in the workforce.1 The survey, developed by an advisory committee who examined the environment for issues they believe will shape health-system pharmacy in the coming 5 years, received 250 responses from chief pharmacy officers and directors, clinical pharmacists, practitioners, faculty members, and other leaders in the pharmacy field.
Joseph T. DiPiro, PharmD, FCCP, FAAAS, editor of the Pharmacy Forecast and associate vice president of faculty affairs at the Virginia Commonwealth University in Richmond, said the forecast is not meant to be a prediction. “It’s not that we would look back at this in a year or 2 and say [whether] we were right or wrong…[it’s] really to open up discussion [and] put issues on people’s radars as they’re working, typically within the health systems for planning,” DiPiro said. “We feel like we’ve done a good job with it if it generates discussion and thinking…[and gets] people planning for eventualities.”
Among the topics discussed in the 2024 forecast, the mental health crisis in the United States has received a significant amount of attention over the past few years. Although mental health has long been deteriorating in the country, as evidenced by the increasing percentage of Americans who utilize mental health care services,2 the issue was exacerbated by the COVID-19 pandemic. According to a study published in JAMA Health Forum, Cantor et al found that mental health care service utilization in August 2022 was 39% higher than in January 2019.3
As of February 2023, 3 in 10 adults reported experiencing anxiety and depression, which are 2 of the most common symptoms associated with mental health illness.4 After decreasing in 2019 and 2020, suicide deaths reached an all-time high in 2022, with the CDC reporting 14.3 deaths per 100,000 people.5 Additionally, more than 111,000 people died from a drug overdose in the 12-month period ending April 2023, fueled largely by the rise in synthetic opioids such as fentanyl.6
READ MORE: Patients Experiencing Depression Preferred In-Person Visits During the COVID-19 Pandemic
The mental health crisis in the United States is evolving rapidly and can be seen throughout all segments of society. It is essential that health systems and pharmacists are prepared to deal with this public health emergency by responding effectively through proper training and improving medication adherence.
A Lack of Mental Health Professionals
With the unprecedented rise in mental health illness in the United States, professionals who are trained to deal with it are needed now more than ever. However, there is currently a lack of mental health professionals in the workforce. Data from the US Health Resources and Services Administration indicates that more than 150 million Americans live in a federally designated mental health workforce shortage area.7
Pharmacy Forecast survey respondents seemed to recognize that there was an unmet need, with 69% saying they believed it was likely that accreditors will require mental health training for patient care staff to respond to mental health and substance use issues by 2028. But how can health care organizations also help create career paths and training programs to meet the growing demand? According to Vicki Ellingrod, PharmD, FCCP, FACNP, Dean and John Gideon Searle Professor of Pharmacy at the University of Michigan College of Pharmacy in Ann Arbor, it all boils down to money.
“We need to be reimbursed for services that we’re providing [and] be recognized for the services that we can provide, at least in the pharmacy profession,” Ellingrod said. “As part of that…once those services are being recognized financially, [there are] more opportunities for training. If you look at the budgets of the National Institutes of Health [NIH], mental health is one of the lower-funded institutes compared [with] cancer and all the other ones. I think that’s also created some of the struggle, because then you don’t have the NIH training programs, either, to help people develop into mental health researchers.”
In their recommendations, the authors of the mental health section of the Pharmacy Forecast, Todd W. Nesbit, PharmD, MBA, FASHP, CPEL, and Tanya J. Fabian, PharmD, PhD, BCPP, said health systems should “prioritize mental health education and skills training for all direct care staff.” They also recommended that health systems partner with academic institutions to create career development programs that will help produce competent professionals for the mental health workforce.
Medication Adherence: A Primary Issue
Pharmacotherapy plays an essential role in treating mental health disorders, but adherence to medication among this patient population is a serious issue. In a study published in Systematic Reviews, Semahegn et al found that 49% of patients with a major psychiatric disorder (eg, schizophrenia, depression, and bipolar disorder) were nonadherent to their medication. They cited various reasons for this, including individual patient behavior, lack of social support, and health system factors.8
Medications to treat patients with opioid use disorder have also been well documented to be beneficial. Methadone, buprenorphine, and naltrexone have all been found to reduce opioid use and disorder-related symptoms, but medication adherence in this population is also lacking. A meta-analysis conducted by Hutchison et al found that adherence among patients with opioid use disorder was only 56%.9
READ MORE: City of Boston Sues Major PBMs Over Role in Opioid Crisis
To improve outcomes for both mental health disorders and opioid use disorders, health systems must find ways to ensure that patients take their medications. Although this is anything but an easy task, Ellingrod believes there are things that can help.
“Education is part of it,” Ellingrod said. “Take the time to actually educate and have patients understand why they need to take their medication. The other thing is, in our messy health care system, patients don’t feel like they’re really being seen. I think testing can help with that and really narrow down the choices for that patient early on so they can get an adequate response.”
The Role of the Pharmacist
As medication experts, pharmacists in all practice settings are well positioned to play a key role in combating the national mental health crisis. Nesbit and Fabian noted that pharmacists can help in many aspects, from screening and early intervention to disease state and comprehensive medication management. Their recommendations included integrating pharmacists with mental health care experience into health systems as part of a collaborative care model.
Pharmacists who work in the community practice setting are crucial members of the care team.10 These practitioners are indispensable, as they can recognize symptoms associated with mental illness, assist with triaging patients to the care providers they need, serve as an educational resource, and closely monitor medication adherence.10 Ellingrod echoed those sentiments.
“We have a huge role to play, especially [as] the medication experts,” Ellingrod said. “We can do a lot with patient education. We can do a lot with medication management. I think that’s where we really shine—looking at the patient, talking to them about family history, [about] their history…that really helps us home in on what might be the best medication for a patient, whether [that’s] in an ambulatory care setting, or…a hospital or in a community pharmacy setting.”
It’s clear that the mental health crisis in the US is becoming worse, but there are measures that can be taken to help improve patient outcomes. Health systems are the first line of defense, and the pharmacist’s role within that setting cannot be overlooked. The public health crisis is sure to be a challenge for years to come, but by expanding education around mental illness, training a more competent workforce, and erasing stigmas, much can be done to alleviate the burden.
READ MORE: Mental and Behavioral Health Resource Center
References
1. DiPiro JT, Hoffman JM, Schweitzer P, et al. ASHP and ASHP Foundation Pharmacy Forecast 2024: strategic planning guidance for pharmacy departments in hospitals and health Systems. Am J Health Syst Pharm. 2024;81(2):5-36.doi:10.1093/ajhp/zxad231
2. Wang J, Qiu Y, Zhu X. Trends of mental health care utilization among US adults from 1999 to 2018. BMC Psychiatry. 2023;23(1):665. doi:10.1186/s12888-023-05156-2
3. Cantor JH, McBain RK, Ho P, Bravata DM, Whaley C. Telehealth and in-person mental health service utilization and spending, 2019 to 2022. JAMA Health Forum. 2023;4(8):e232645. doi:10.1001/ jamahealthforum.2023.2645
4. Panchal N, Saunders H, Rudowitz R, Cox C. The implications of COVID-19 for mental health and substance use. News Brief. KFF. March 20, 2023. Accessed January 22, 2024. https://www.kff.org/mentalhealth/issue-brief/the-implications-of-covid-19-for-mental-healthand-substance-use/
5. Curtin SC, Garnett MF, Ahmad FB. Provisional estimates of suicide by demographic characteristics: United States, 2022. CDC. November 29, 2023. Accessed January 22, 2024. https://stacks.cdc.gov/view/ cdc/135466
6. Rossen LM, Ahmad FB, Spencer MR, et al. Methods to adjust provisional counts of drug overdose deaths for underreporting. CDC. August 2018. Accessed January 22, 2024. https://www.cdc.gov/nchs/ data/nvss/vsrr/NVSS-methods-drug-adjustment.pdf
7. Saunders H, Guth M, Eckart G. A look at strategies to address behavioral health workforce shortages: findings from a survey of state Medicaid programs. KFF. January 10, 2023. Accessed January 22, 2024. https://www.kff.org/mental-health/issue-brief/a-lookat-strategies-to-address-behavioral-health-workforce-shortagesfindings-from-a-survey-of-state-medicaid-programs/
8. Semahegn A, Torpey K, Manu A, Assefa N, Tesfaye G, Ankomah A. Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: a systematic review and meta-analysis. Syst Rev. 2020;9(1):17. doi:10.1186/s13643-020-1274-3
9. Hutchison M, Russell BS, Leander A, et al. Trends and barriers of medication treatment for opioid use disorders: a systematic review and meta-analysis. J Drug Issues. Published online October 11, 2023. doi:10.25384/SAGE.c.6876589.v1
10. Moore CH, Powell BD, Kyle JA. The role of the community pharmacist in mental health. U.S. Pharmacist. November 15, 2018. Accessed January 24, 2024. https://www.uspharmacist.com/article/ the-role-of-the-community-pharmacist-in-mental-health
