Mental health is a key part of a community pharmacist’s remit. One award-winning pharmacy has enthusiastically taken on issues around post-natal depression, as Ade Williams reveals…
The Health and Social Care Act 2012 created a legal responsibility for the NHS to deliver parity of esteem between mental and physical health and the government pledged to achieve this by 2020.
This Act continues to be viewed by many as a missed opportunity to embed community pharmacy as a front-line NHS service while the lack of mention of our role in the parity objectives and initiatives is very disappointing. In January 2016, the then prime minister David Cameron pledged a revolution in mental health treatment when announcing a billion pounds of investment to enhance mental health services across the country.
So the recent announcement by NHS England in May this year that an additional £20 million will be spent on services in underserved parts of the country, providing increased access to perinatal mental health care within the next year for new and expectant mothers, is welcome.
This recent announcement it is hoped will help the government fulfil its stated pledge and rightly ensure the best care is now delivered. A 2014 estimate found that only 3% of the country had good access to perinatal mental health care.
The community pharmacy team are well placed to help identify signs and symptoms of postnatal depression. They can offer appropriate support and signpost accordingly to enable quick access to the necessary help.
Postnatal depression can develop gradually and can be hard to recognise. Some parents may avoid talking to family and friends about how they are feeling because they worry they will be judged for not coping or not appearing happy.
It is, however, a common problem, affecting more than one in 10 women within a year of giving birth. The signs the pharmacy team may be able to pick up on with affected patients include:
• Neglecting themselves such as not washing or changing their clothes.
• Losing all sense of time such as being unaware whether 10 minutes or two hours have passed.
• Always worrying that something is wrong with their baby regardless of reassurance.
• A persistent feeling of sadness and low mood.
• Lacking energy and feeling tired all the time.
• Trouble sleeping at night and feeling sleepy during the day.
• Feeling unable to look after their baby.
• Loss of appetite or increased appetite (comfort eating).
It is essential that the pharmacy team deal with cases sensitively and cautiously and are mindful that, especially in the early days after childbirth, it can be a very emotionally and physically tiring time. It is not uncommon for women to feel a bit down, tearful or anxious in the first week after giving birth.
Some of the factors associated with postnatal depression include:
• A history of mental health problems during pregnancy.
• A history of depression.
• Having no close family or friends to support.
• Poor relationship with their partner.
• Recent stressful life events, such as a bereavement.
This year our team at Bedminster Pharmacy are trying to inquire about mental wellbeing during all our patient interactions. We now even have a specific day set aside weekly to focus on mental health awareness.
During a recent medicines use review consultation, a male diabetic patient appeared to have lost motivation to comply with his medications. He confessed to having an unhealthy diet which resulted in him gaining weight.
As we discussed it further, he revealed that his wife was showing signs which we knew were indicative of postnatal depression. Their new child was now nine months old. His wife had a previous history of depression.
We were able to provide him with information on postnatal depression and encourage him to discuss with his wife how to access the support available. We also let him know that postnatal depression can also affect fathers and partners although this is less common. He consented to us discussing our concerns about him with his GP.
A few days later he came in with his wife after their GP appointment. They were emotionally very raw but relieved to know they now had the support to get better. And they were grateful for the pharmacy ’s proactive involvement.
Our experience most certainly mirrors what many other colleagues do in their community. Our multi-generational caring relationships and easy access enable us to support mental wellbeing in a variety of situations.
Becoming part of a multi-disciplinary community-based solution means we can use our unique expertise and broad reach to address people’s distinct needs.
However, the lack of engagement with community pharmacy to help deliver the objectives of mental and physical health equity is very concerning.
It is commendable that the Royal Pharmaceutical Society is doing some work that may help redress this. Left uncorrected, it risks many laudable goals like those for perinatal mental health care going unfulfilled.
Ade Williams is a pharmacist at Bedminster Pharmacy in Bristol who won the innovation award at last year’s Pharmacy Business Awards.