Trigger warning: This article discusses mental health and suicide which some readers may find distressing. For your own support you can link in with your GP, or call the HSE YourMentalHealth Information Line on freephone 1800 111 888, any time day or night.
Male mental health statistics are well documented, with middleaged Irish men presenting with the highest suicide rates in Ireland.1 A recently published systematic review of male suicide risk reported a link between cultural masculinity and suicide risk. Men don’t want to appear “weak” by showing signs of struggling with their mental health, and are generally less likely than their female counterparts to talk through their feelings. They also tend to devalue their interpersonal needs. Recommendations from this review included supporting men to understand and regulate their emotions, and to build meaningful connections.2
But how can pharmacy help with this? Below are some key ways that pharmacists and pharmacy staff can support men’s mental health and wellbeing in the community.
Leveraging accessibility
Samaritans’ research shows that less than 20% of men who are experiencing mental health difficulties will seek help from a mental health professional, and less than 35% will speak to their GP during a tough period.3 In contrast, pharmacists are the most accessed healthcare professionals in Ireland, with a reported 1.5 million visits to pharmacies each week,4 and people visiting their community pharmacy up to ten times more often than they visit their GPs.5 Polls consistently show high levels of trust in the local pharmacist, with 93% of respondents stating their trust in an Irish 2022 report.6
Therefore, community pharmacy pharmacists are in a unique position to leverage this accessibility to engage men in relation to their mental health. This can be beneficial for the outcomes of regular patients, male carers of patients, or general male members of the public who wish to avail of support or advice. Making time for an informal supportive conversation, using appropriate signage to welcome mental health queries, and utilising the consultation room for privacy can all encourage broaching of the topic by men who ordinarily may hesitate to do so.
Identifying new/deteriorating symptoms
Pharmacists get to know their patients very well, and through vigilance and rapport with their male attendees can identify changes in behaviour and early signs of mental health problems that otherwise wouldn’t typically be vocalised by this cohort. This includes anxiety, depression, post-traumatic stress disorder, and substance or alcohol abuse, which men are more prone to. Early intervention in these instances is key, and being able to spot them quickly is the vital first step in support.
Skilled consultation
Pharmacists have the potential to make a real difference through their conversations with patients, however being empowered to ask the right questions in relation to mental health and suicidal intent is important.7 Recent research of Irish community pharmacists and staff highlighted a lack of training and confidence in suicide prevention,8 despite the availability of various online and in person educational offerings via the National Office of Suicide Prevention and Irish Institute of Pharmacy.9 Pharmacies can consider proactively upskilling staff in this area, which would improve the support offered to men who are struggling.
Medication management
Pharmacists self-identify as gatekeepers to medications that can cause harm, such as over the counter paracetamol and sedatives, as well as prescription drugs8 and have an important role to play in reducing access to means of suicide or selfharm, which is Goal 6 from the Connecting for Life Mental Health strategy.10 A national working group have recently launched an educational campaign in relation to adherence to paracetamol sales guidelines in pharmacy and retail settings. This work is in response to high levels of intentional paracetamol overdose, and further information is available at healthpromotion.ie.
When providing medications to patients, pharmacists are in a position to open the conversation around patients’ mental health improvement or deterioration, medication side effects, and optimal use of medications to support male mental health.
Behavioural support
Pharmacists are trained to provide positive wellbeing behavioural change support to those struggling with their mental health. Helping to start the conversation around detrimental coping strategies such as excess alcohol consumption can encourage a desire to improve wellbeing. General advice provided around nutrition, hydration, sleep, exercise and stress management can all contribute to wellbeing improvements, and is well within the pharmacist’s scope of practice and the updated Domain 5
Public Health in the PSI’s Core Competency Framework.11 Linking in with somebody regularly to create accountability around
personal wellbeing has the potential to be very helpful for male patients, and community pharmacies can offer to be that check-in point for them.
Signposting
Keeping up to date on local and national mental health resources is advisable, to appropriately signpost patients. Spending a little time researching this in your own community, and knowing the details of mental health services such as counsellors, as well as social initiatives in the area such as Men’s Sheds, walking or book clubs, will all be helpful information for men who wish to increase their connection and combat loneliness. The Irish Men’s Sheds Association supports over 450 locations on the island of Ireland, up to 10,000 men come together weekly to share skills, make friendships and learn from one another.12
Referral
Pharmacists can be the catalyst for real tangible action for men who are struggling with their mental health, and an important skill of such support is knowing when and where to refer.
In cases where minimal support is needed, or as part of a bigger support offering, social prescribing is a new and innovative national initiative from the HSE to which healthcare professionals can refer patients to. It enables people with social, emotional or practical needs to improve their health and wellbeing, often using services provided by the community and voluntary sector. More information about this initiative can be found online.13
Very importantly, referrals for more significant mental health struggles should be referred to the below resources, to the patient’s GP, or in more pressing cases of distress or suicide risk, the emergency services on 112 or 999.
Men’s mental health is an ongoing challenge, and community pharmacy is excellently placed to offer accessible, supportive care through medication management, wellbeing education, connection, appropriate local signposting and referral. Keeping the conversation open, remaining up to date, and normalising mental health challenges will help to empower men to seek the support they require.
Support information
– If you, or someone you know, needs support or is in crisis, contact your local GP.
– In an emergency, go to/contact the Emergency Department of your nearest hospital or ring 999 for Emergency Services.
– Text About It is a free 24-hour anonymous messaging service for people in crisis. Text HELLO to 50808
– Samaritans provide a 24-hour listening services, free of charge. Phone 116 123 or email jo@samaritans.org
– Further help seeking information: www.yourmentalhealth.ie
Suicide reporting guidelines: Available at http://www. samaritans.org/your-community/samaritans-work-ireland/ media-guidelines-ireland
References
1. Health Services Executive. Middle aged men and suicide report. March 2018. Available at https:// www.hse.ie/eng/services/list/4/ mental-health-services/connectingfor-life/publications/ middle-aged-menand-suicide-inireland-report. html. Accessed 1.10.2023
2. Bennett S, Robb KA, Zortea TC, Dickson A, Richardson C, O’Connor RC. Male
suicide risk and recovery factors: A systematic review and qualitative metasynthesis of two decades of research. Psychological Bulletin. 2023 Jul;149(7-8):371.
3. Irish Mens Shed Associaton. When was your last service? Available at https://malehealth.ie/ Accessed 1.10.2023
4. Irish Pharmacy Union, 2023. Submission in relation to Budget 2023. Accessed via htps://ipu. ie/ipu-document/ipupre-budgetsubmission-2023/ on 14th July 2023.
5. Reference Tsuyuki RT, Beahm NP, Okada H, Al Hamarneh YN. Pharmacists as accessible primary
health care providers: Review of the evidence. Can Pharm J. 2018;151(1):4–5.
6. IPSOS Veracity Index 2022. Available from: htps://www.ipsos.com/en-ie/ ipsos-veracity-index-2022 [accessed 7th July 2023]
7. Health Service Executive –Supporting someone how might be suicidal. Available at https:// www2.hse.ie/mental-health/helpingsomeone-else/someone-who-mightbe-suicidal/. Accessed 1.10.2023.
8. O’Driscoll M, Carpenter DM, Foley A, Moloney E, Reddin K, Sahm LJ. A needs assessment for suicide prevention training within community pharmacies. Explor Res Clin Soc Pharm. 2023 Jun 1;10:100285. doi: 10.1016/j.rcsop.2023.100285. PMID: 37333967; PMCID: PMC10276177.
9. Irish Institute of Pharmacy. Mental Health and Wellbeing. Available at https://iiop.ie/content/mental-healthwellbeing. Accessed on 1.10.2023.
10. Health Service Executive. Connecting for Life. Available at https://www.hse.ie/eng/services/ list/4/mental-health-services/ connecting-for-life/ Accessed 1.10.2023
11. Pharmaceutical Society of Ireland. Core Competency Framework. Available at https://www.thepsi. ie/Libraries/Education/PSI_Core_ Competency_Framework_for_ Pharmacists.sflb.ashx Accessed 1.10.2023
12. Irish Mens Shed Association. What is a men’s shed. Available at https:// menssheds.ie/about-mens-sheds/ Accessed 1.10.2023
13. Health Service Executive. Social Prescribing. Available at https:// www.hse.ie/eng/about/who/ healthwellbeing/our-priorityprogrammes/mental-health-andwellbeing/social-prescribing/ Accessed 1.10.2023
Authors:
Dr Michelle O’Driscoll is a Postdoctoral Researcher at the National Suicide Research Foundation (NSRF), and Clinical Pharmacy Lecturer at University College Cork (UCC). She is the current co-ordinator (with Dr Caroline Daly) of the national Preventing Paracetamol-Related Intentional Drug Overdose Working Group, and is developing with the NSRF and the National Office of Suicide Prevention (NOSP) a national suicide prevention curriculum for undergraduate healthcare students.
Laura J Sahm is Professor of Clinical Pharmacy in the School of Pharmacy UCC. One of her research areas relates to serious mental illness and the ways in which pharmacists can work as part of the multidisciplinary team to improve patient outcomes.
