World Mental Health Day
By Etashe Okpola
Pharmacists, as the most accessible healthcare professionals, are tasked with meeting a variety of drug-related needs. These include responding to medication requests, patient assessment and counselling, providing drug information to both patients and other healthcare professionals, maintaining policies, drug and drug item design, and generally partaking at the forefront of drug matters.
With the industry’s transition to pharmaceutical care, the role of the pharmacist within the clinical setting presents a higher demand to meet patients’ needs and ensure optimal patient outcomes. Pharmaceutical care is a patient-centered care model requiring the establishment of a professional relationship with patients, collection of patient subjective and objective data, patient evaluation and identification of drug therapy problems, development and implementation of a personalized pharmaceutical care plan, evaluation of interventions and follow-ups, and the documentation of activities (Oparah, 2005, p. 31). This model of pharmacy practice is designed to achieve positive clinical outcomes and has enhanced the role of the pharmacist in promoting holistic health across a large number of communities. However, pharmaceutical care presents newer challenges in the amount of workload available to the pharmacist, which in turn exposes pharmacists to mental and physical stress. In a study published by the Journal of the American Medical Informatics Association, 70% of physicians who use electronic health records (EHR) reported stress related to Health Information Technology (HIT). This stress was most prevalent in primary care-oriented specialties. Physicians also reported stress-induced by poor/marginal time for documentation and additional daily frustration from the use of EHR (Gardner et al., 2019). Thus showing that, with the advent of modern technology, pharmacists must meet additional hours of documentation that potentially induce mental and physical stress.
Additionally, the emergence of the Covid19 pandemic has resulted in increased work hours for health professionals in the clinical setting. This event reveals the potential of pandemics, which generally develop unexpectedly, to expose pharmacists to a higher degree of mental stressors.
Mental stress is defined by Lazarus & Folkman, in 1984, as a form of stress that occurs because of how an event in one’s external or internal environment is perceived, resulting in the psychological experience of distress and anxiety (Salomon, 2013). As champions of patient-centered care, the need for prioritizing mental health care for the pharmacist often eludes one’s attention. This oversight, alongside the increasing workload and threat induced by pandemics, has the potential to cause a decline in the mental health of pharmacists, subsequently leading to negative healthcare outcomes.
Work Environment and Mental Health
Work environment, workload, and work hours are important factors that play a role in performance and outcome at the workplace. The increasing focus on pharmaceutical care is a path that results in a greater degree of workload for the pharmacist, which is accompanied by increased work hours, especially in economies with an insufficient number of healthcare professionals.
In a 2014 National Pharmacist Workforce survey prepared by Midwest pharmacy workforce research consortium, 45% of pharmacists reported having negative mental and emotional health as a result of their workload. This report follows complaints of excessively high workload, by 66% of pharmacists. An annual increase in workload could be another concern as 64% pharmacists confirmed an increase in workload compared to 2013 (Gaither et al., 2014). Community pharmacists, in a research assessing burnout syndrome among healthcare professionals, are reported to have a higher rate of experiencing burnout and lower job satisfaction (Bridgeman et al., 2018).
The increasing need for documentation is another promoter of higher workload. 38% of independent community pharmacists reported having to do excessive paperwork, as their core challenge (Gaither et al., 2014). This practice is driven by factors like inadequate staffing (including the number of pharmacy technicians), and the number of patients served per day, which subsequently leads to an increase in workload, inefficiency, and mental health stress. It is therefore evident that decreased workload is critical in combating workplace stress. Pharmacy practices within the clinical setting require proper staffing — which helps to reduce the pharmacist’s work hours — to curb workplace fatigue.
Additionally, Work performance can become enhanced by an enabling work culture. The occurrence of workplace anxiety is higher for young professionals within a tense environment, limiting creativity and efficiency. Psychological concepts like social facilitation and social loafing, which indicate that performance is sometimes improved while being observed, and other times inhibited in the presence of other people (Mcleod, 2020), explain the need to expose individuals to work models that maximize individual productivity. To enhance work outcome, supervisors should employ flexibility in leadership styles and develop social environments that promote creativity and reduce workplace anxiety.
The Effect of Communication and Community on Mental Health
As a patient-first oriented profession, pharmacists are often hesitant to disclose their mental and emotional wellbeing to colleagues and employees. The overall education process of pharmacists’ conditions individuals to imbibe certain character traits perceived as professionally enhancing. Pharmacists are conditioned to always be on the lookout for problems, put in maximum work effort, and avoid errors. While these work cultures improve the overall outcome of interventions, they further induce stress in an individual. Additionally, the prevalence of mental health stigma across several societies could be a contributing factor that deters pharmacists from disclosing their mental wellbeing.
In certain climes, Pharmacists work as stand-alone staff, particularly within the community setting. Although some individuals perform better in the absence of others, this lack of social interaction with colleagues, paired with long hours, could increase the stress level of pharmacists, thereby negatively affecting their mental health.
Social interaction is an important part of our wellbeing as humans and can be improved with the right community. As an enabler of communication, communities provide a sense of belonging which fosters healthy communication between individuals. And while employees work toward designing enabling work environments, Young pharmacists should choose communities that suit their personalities and encourage openness, and should communicate their mental and emotional stressors with supervisors or colleagues.
The pharmaceutical industry is a rapidly changing environment. Following an increasing focus on patient-first care and technological innovation, factors like heavy workload, lack of enabling environments, insufficient levels of communication, and absence of community remain core threats to the mental wellness of young pharmacists. The research around mental health stress among pharmacists is currently insufficient, and little to no evidence exists around programmes designed to support the mental health of young pharmacists.
Mental health stress alters the brain’s wiring and affects work outcome. Golkar et al, in a study done to assess the influence of work-related chronic stress on the regulation of emotion and functional connectivity in the brain, discovered that the functional couplings within the emotion- and stress-processing limbic networks are altered in individuals who suffer from stress. This alteration results in a reduced ability for such an individual to down-regulate negative emotions (Golkar et al., 2013).
The WHO defines holistic health as encompassing physical, mental, and social health. Mental health is concerned with the wellness of mind. It works in tandem with physical and social health to enable total health. Therefore, when there is a decline in an individual’s mental health, it affects their physical performance, appearance, and social participation.
Promoting the mental wellbeing of pharmacists requires the reconditioning of professional obligations by the educational system. Although traits like being on the lookout for problems, putting in maximum work effort, and avoiding errors enable positive health outcomes, they nonetheless have the potential to induce work fatigue. Therefore, the industry could benefit from mental health programmes designed for pharmacists and a change in social orientation to encourage open conversations around mental wellbeing. Furthermore, the decreased workload can become achieved by adequate staffing, and work (as well as social) environments should become designed to encourage communication. Young pharmacists could also partake in distressing activities like taking walks and meditation, which are known to improve mental wellness.
References
Oparah, A.C. Initials. (2005). Essentials of Pharmaceutical care. University of Benin. Benin. Edo State, Nigeria.
Gardner, R.L., Cooper, E., Haskell, J., Harris, D.A., Poplau, S., Kroth, P.J., Linzer, M. (2019, February). Physician stress and burnout: the impact of health information technology, Journal of the American Medical Informatics Association. Retrieved from: https://doi.org/10.1093/jamia/ocy145
Salomon K. (2013) Mental Stress. In: Gellman M.D., Turner J.R. (eds) Encyclopedia of Behavioral Medicine. Retrieved from: https://doi.org/10.1007/978-1-4419-1005-9_261
Gaither, C.A., Schommer, J.C., Doucette, W.R., Kreling, D.H., Mott, D.A. (2014). 2014 National Sample Survey Of The Pharmacist Workforce To Determine Contemporary Demographic Practice Characteristics And Quality Of Work-life. Retrieved from: https://www.aacp.org/sites/default/files/finalreportofthenationalpharmacistworkforcestudy2014.pdf
Bridgeman, P.J., Bridgeman, M.B., Barone, J. (2018, February 1). Burnout syndrome among healthcare professionals, American Journal of Health-System Pharmacy. Retrieved from: https://doi.org/10.2146/ajhp170460
Mcleod, S. (2020, June 24). Social Facilitation. Retrieved from: https://www.simplypsychology.org/Social-Facilitation.html
Golkar, A., Johansson, E., Kasahara, M., Osika, W., Perski, A., Savic I. (2014, September 3). Retrieved from: https://doi.org/10.1371/journal.pone.0104550
World Health Organization. Constitution. Retrieved from: https://www.who.int/about/who-we-are/constitution
