The Pharmaceutical Journal
Vol 277 (Supplement) F13
October 2006

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FIP Congress 2006

Learning for practice — new teaching

Simon Bell, of the University of Sydney faculty of pharmacy, outlined a programme where people with mental illnesses could help provide education to pharmacists and pharmacy students. Termed “consumer educators”, these are people who have received mental health care and who work to inform and educate individuals, families and society about mental illness.

Mr Bell said that it was important that pharmacists understand mental health because in practice they are taking on a greater role in the management of mental illness. He pointed out that some 450 million people worldwide suffer from mental illness, which represented 13 per cent of the global disease burden.

Yet, 40 per cent of countries do not provide mental health education to primary health care professionals.

In those countries that do provide such education, typically it focuses on the pharmacological properties of medicines and tends not to focus on people’s experiences of taking these medicines. In Australia, students undertake role-playing exercises around the provision of drug information to people with mental illness, but his own research had shown that using simulated patients was proving unrealistic.

He had also found that clinical practice experience in hospital and community pharmacy workplaces often did not improve students’ attitudes towards mentally ill people. It had been shown that a large social distance from people with mental illnesses may mean that health care professionals do not understand people’s experiences of their illnesses.

Indeed, pharmacists feel less comfortable providing services to people with mental illness than to those with, say, cardiovascular disease. And research in Finland had shown that pharmacists are less likely to provide counselling on the use of psychotropic medicines than they are for eight other classes of medicines.

To combat these problems, the University of Sydney designed an education partnership through consultation with key stakeholders, including professional associations representing pharmacists, the Schizophrenia Fellowship of New South Wales and local area mental health services. The result was that four two-hour education sessions were held in March 2005, which involved five consumer educators, one care-giver and seven pharmacists. The results were revealing.

Consumer educators told pharmacists that they, the pharmacists, were sometimes selective in whom they related to; they did not want “scenes” in the pharmacy and they sometimes rated patients according to the drugs they gave them. They certainly believed that people with mental illnesses were treated differently.

Pharmacists said that they derived value from participation in the partnership. They began to realise that there was no need to be scared to ask mentally ill people about how they were coping with their medicines and were surprised at how open these patients were in sharing their experiences of their illness and medication.

The university decided to evaluate whether this approach might be more valuable to students than traditional lectures and tutorials. So it set up a trial to compare a control group, which received standard education about mental illness, and a test group, which received the same teaching but with the added availability of a consumer educator during tutorials. (Consumer educators were paid by the university in the same way as other tutors. It was thought essential to regard them as experts in their own illnesses.)

An overall “social distance score” was devised using seven “items” (share a flat, have as a work colleague, have as a neighbour, have as a baby sitter, have your child marry, introduce to a single friend, and recommend for a job) and a five-point Likert scale. In the control group this score totalled 18.90 before teaching and 18.67 after. In the test group the scores were 18.60 before and 16.69 after (P=0.02). So the test group emerged with significantly improved attitudes towards people with mental illness.

Mr Bell told the congress that his study suggested that consumer participation in mental health pharmacy education can improve students’ attitudes. It is also possible that participation in the education partnership has benefits for the consumer educators in terms of greater self esteem, although these potential benefits were not assessed in the study.

He concluded that attitudes towards people with mental illness comprise one component of pharmacists’ willingness to provide services to people with mental illness. But future studies are needed to determine whether improvements in student’s attitudes are sustained over time.