International Journal of Clinical Pharmacy

, Volume 40, Issue 5, pp 1096–1105 | Cite as

Community pharmacists and mental illness: a survey of service provision, stigma, attitudes and beliefs

  • Vincent GiannettiEmail author
  • Charles F. Caley
  • Khalid M. Kamal
  • Jordan R. Covvey
  • Jerry McKee
  • Barbara G. Wells
  • Dean M. Najarian
  • Tyler J. Dunn
  • Pratyusha Vadagam
Research Article


Background Half of Americans experience mental illness during their lifetime. Significant opportunity exists for community pharmacists to deliver services to these patients; however, personal and practice-related barriers may prevent full engagement. Objective To assess the demographics, practice characteristics, service provision, stigma, attitudes and beliefs of a national sample of community pharmacists towards individuals with mental illness. Setting National random sample of 3008 community pharmacists in the USA. Method 101-item cross-sectional mailed survey questionnaire on: (1) demographics, (2) knowledge and practice characteristics, (3) provision of clinical pharmacy services, and (4) comparative opinions. Main outcome measure Scaled measures of service provision (comfort, confidence, willingness and interest) and comparative opinions (stigma, attitudes and beliefs) of mental illness, four linear regression models to predict service provision. Results A total of 239 responses were received (response rate 7.95%). Across pharmacy services, ratings for willingness/interest were higher than those for comfort/confidence. Pharmacists who reported providing medication therapy management (MTM) services for patients reported higher comfort (18.36 vs. 17.46, p < 0.05), confidence (17.73 vs. 16.01, p < 0.05), willingness (20.0 vs. 18.62, p < 0.05) and interest (19.13 vs. 17.66, p < 0.05). Pharmacists with personal experience with mental illness also resulted in higher scores across all four domains of service provision, lower levels of stigma (18.28 vs. 20.76, p < 0.05) and more positive attitudes (52.24 vs. 50.53, p < 0.01). Regression analyses demonstrated increased frequency of MTM service delivery and more positive attitudes as significantly predictive across all four models for comfort, confidence, willingness and interest. Increased delivery of pharmacy services was significantly associated with both willingness and interest to provide mental illness-specific services. Conclusion Despite willingness/interest to provide services to patients with mental illness, decreased levels of comfort/confidence remain service-related barriers for community pharmacists.


Community pharmacy Community pharmacy services Mental disorders Pharmacist knowledge Pharmacist attitudes Questionnaire Social stigma 



We would like to thank Hannah Cawoski, Somraj Ghosh, Ankur Dashputre and Mousam Parekh for their initial contributions to the construction of the survey instrument used in this study.


The authors acknowledge funding for this study received from Johnson and Johnson.

Conflicts of interest

KMK and JRC have received grant funding from Novartis Pharmaceuticals Corp. DMN is an employee of Janssen Scientific Affairs, LLC. The other authors have nothing to disclose. Two posters related to this research were presented at the College of Psychiatric and Neurologic Pharmacists Annual Meeting in Phoenix, AZ, April 2017, and one related poster was presented at the American College of Clinical Pharmacy Virtual Poster Symposium, May 2017.

Supplementary material

11096_2018_619_MOESM1_ESM.docx (219 kb)
Supplementary material 1 (DOCX 219 kb)
11096_2018_619_MOESM2_ESM.docx (15 kb)
Supplementary material 2 (DOCX 14 kb)
11096_2018_619_MOESM3_ESM.docx (14 kb)
Supplementary material 3 (DOCX 14 kb)


  1. 1.
    Center for Behavioral Health Statistics and Quality. Behavioral health trends in the United States: results from the 2014 National Survey on Drug Use and Health (HHS publication no. SMA 15-4927, NSDUH series H-50) [internet], Rockville. 2015. Accessed 14 Feb 2018.
  2. 2.
    Reeves WC, Strine TW, Pratt LA, Thompson W, Ahluwalia I, Dhingra SS, et al. Mental illness surveillance among adults in the United States. MMWR. 2011;60:Suppl 1–29.Google Scholar
  3. 3.
    Brooks M. Top 100 most prescribed, top selling drugs [internet]. 2014. Accessed 14 Feb 2018.
  4. 4.
    Munger M, Walsh M, Godin J, Feehan M. Pharmacist's demand for optimal primary care service delivery in a community pharmacy: the OPTiPharm study. Ann Pharmacother. 2017. Scholar
  5. 5.
    IMS Health. National pharmacy market survey: Market insights report [internet]. 2017. Accessed 14 Feb 2018.
  6. 6.
    Walgreens. Walgreens addresses growing need for mental health resources with new platform, campaign and access to expanded services [internet]. 2016. Accessed 14 Feb 2018.
  7. 7.
    Mental Health Pharmacies. The mental health pharmacy directory [internet]. Accessed 14 Feb 2018.
  8. 8.
    College of Psychiatric and Neurologic Pharmacists Foundation, National Alliance on Mental Illness. Characterizing the relationship between individuals with mental health conditions and community pharmacists [internet], Lincoln. 2012. Accessed 14 Feb 2018.
  9. 9.
    Calogero S, Caley CF. Supporting patients with MI: deconstructing barriers to community pharmacist access. J Am Pharm Assoc. 2003;2017(57):248–55.Google Scholar
  10. 10.
    O’Reilly CL, Bell JS, Kelly PJ, Chen TF. Exploring the relationship between mental health stigma, knowledge and provision of pharmacy services for consumers with schizophrenia. Res Soc Adm Pharm. 2015;11:e101–9.CrossRefGoogle Scholar
  11. 11.
    Rickles NM, Dube GL, McCarter A, Olshan JS. Relationship between attitudes toward MI and provision of pharmacy services. J Am Pharm Assoc. 2003;2010(50):704–13.Google Scholar
  12. 12.
    Phokeo V, Sproule B, Raman-Wilms L. Community pharmacists’ attitudes toward and professional interactions with users of psychiatric medications. Psychiatr Serv. 2004;55:1434–6.CrossRefGoogle Scholar
  13. 13.
    Murphy AL, Phelan H, Haslam S, Martin-Misener R, Kutcher SP, Gardiner DM. Community pharmacists’ experiences in MI and addictions care: a qualitative study. Subst Abuse Treat Prev Policy. 2016;11:6.CrossRefGoogle Scholar
  14. 14.
    Gardner DM, Murphy AL, Woodman AK, Connelly S. Community pharmacy services for antidepressant users. Int J Pharm Pract. 2001;9:217–24.CrossRefGoogle Scholar
  15. 15.
    Hoch MA, Ott CA, Hudmon KS, Plake KS. Attitudes of individuals with schizophrenia towards pharmacists. J Am Pharm Assoc. 2003;2012(52):783–6.Google Scholar
  16. 16.
    Knox K, Fejzic J, Mey A, Fowler JL, Kelly F, McConnell D, et al. Mental health consumer and caregiver perceptions of stigma in Australian community pharmacies. Int J Soc Psychiatry. 2014;60:533–43.CrossRefGoogle Scholar
  17. 17.
    Thornicroft G. Most people with MI are not treated. Lancet. 2007;370:807–8.CrossRefGoogle Scholar
  18. 18.
    Barney LJ, Griffiths KM, Jorm AF, Christensen H. Stigma about depression and its impact on help-seeking intentions. Aust NZ J Psychiatry. 2006;40:51–4.CrossRefGoogle Scholar
  19. 19.
    Mental Health Council of Australia. Consumer and carer experiences of stigma from mental health and other health professionals [internet]. Canberra. 2011. ISBN 978-0-9807007-6-3. Accessed 14 Feb 2018.
  20. 20.
    Thornicroft G, Rose D, Kassam A, Sartorius N. Stigma: ignorance, prejudice or discrimination? Br J Psychiatry. 2007;190:192–3.CrossRefGoogle Scholar
  21. 21.
    Scheerder G, De Coster I, Van Audenhove C. Community pharmacists’ attitude toward depression: a pilot study. Res Social Adm Pharm. 2009;5:242–52.CrossRefGoogle Scholar
  22. 22.
    Kassam A, Papish A, Modgill G, Patten S. The development and psychometric properties of a new scale to measure MI related stigma by health care providers: the opening minds scale for health care providers (OMS-HC). BMC Psychiatry. 2012;12:62.CrossRefGoogle Scholar
  23. 23.
    Liekens S, Smits T, Laekeman G, Foulon V. Factors determining social distance toward people with depression among community pharmacists. Eur Psychiatry. 2012;27:528–35.CrossRefGoogle Scholar
  24. 24.
    Dipaula BA, Qian J, Mehdizadegan N, Simoni-Wastila L. An elective psychiatric course to reduce pharmacy students’ social distance toward people with severe MI. Am J Pharm Educ. 2011;75:72.CrossRefGoogle Scholar
  25. 25.
    Dillman DA. Mail and internet surveys: a tailored design method. New York: Wiley; 2000. p. 178–81.Google Scholar
  26. 26.
    Goffman E. Stigma: notes on the management of spoiled identity. Englewood Cliffs: Prentice-Hall; 1963. p. 41–3.Google Scholar
  27. 27.
    Hogg MA, Vaughan GM. Social psychology. 8th ed. London: Pearson; 2018. p.154–61.Google Scholar
  28. 28.
    United States Census Bureau. Regions. 2015. Accessed 19 Feb 2018.
  29. 29.
    Maslen CL, Rees L, Redfern PH. Roles of the community pharmacist in the care of patients with chronic schizophrenia in the community. Int J Pharm Pract. 1996;4:187–95.CrossRefGoogle Scholar
  30. 30.
    Bell JS, Whitehead P, Aslani P, Sacker S, Chen TF. Design and implementations of an educational partnership between community pharmacists and consumer educators in mental health care. Am J Pharm Educ. 2006;70:28.CrossRefGoogle Scholar
  31. 31.
    Rubio-Valera M, Chen TF, O’Reilly CL. New roles for pharmacists in community mental health care: a narrative review. Int J Environ Res Public Health. 2014;11:10967–90.CrossRefGoogle Scholar
  32. 32.
    Mey A, Fowler JL, Knox K, Shum DHK, Fejzic J, Hattingh L, et al. Review of community pharmacy staff educational needs for supporting mental health consumers and carers. Community Ment Health J. 2014;50:59–67.CrossRefGoogle Scholar
  33. 33.
    Cannon-Breland ML, Westrick SC, Kavookjian J, Berger BA, Shannon DM, Lorenz RA. Pharmacist self-reported antidepressant medication counseling. J Am Pharm Assoc. 2003;2013(53):390–9.Google Scholar
  34. 34.
    Task Force on Specialty Recognition of Psychopharmacy Practice. Executive summary of petition requesting recognition of psychopharmacy. Am J Hosp Pharm. 1991;48:1284–90.Google Scholar
  35. 35.
    Marken PA, Evans RL. Survey of psychopharmacy curricula and faculty at schools of pharmacy. Am J Pharm Educ. 1993;57:330–2.Google Scholar
  36. 36.
    Dopheide JA, Bostwick JR, Goldstone LW, Gable K, Thomas KL, Cates ME, et al. A 2015 survey of pharmacy curriculum in psychiatry and neurology in the United States. J Pharm Pract. 2016;29:274.Google Scholar
  37. 37.
    Martello JL, Kreys TJ, Paxos C, Thornton A. Survey of psychiatric pharmacy education at US schools of pharmacy. Curr Pharm Teach Learn. 2016;8:782–7.CrossRefGoogle Scholar
  38. 38.
    Cates ME, Monk-Tutor MR, Drummond SO. Mental health and psychiatric pharmacy instruction in US colleges and schools of pharmacy. Am J Pharm Educ. 2007;71:4.CrossRefGoogle Scholar
  39. 39.
    Slain D, Wong-Barringer A, Blake B, Bumgardner M, Rowen R, Schonder K, et al. Pharmacotherapy didactic curriculum toolkit 2009 [internet]. 2009. Accessed 14 Feb 2018.
  40. 40.
    American Society of Consultant Pharmacists. Geriatric pharmacy curriculum guide, 3rd edn [internet], Alexandria. 2016. Accessed 14 Feb 2018.
  41. 41.
    Gable KN, Muhlstadt KL, Celio MA. A mental health elective to improve pharmacy students’ perspectives on MI. Am J Pharm Educ. 2011;75:34.CrossRefGoogle Scholar
  42. 42.
    Patten SB, Remillard A, Phillips L, Modgill G, Szeto ACH, Kassam A, et al. Effectiveness of contact-based education for reducing MI-related stigma in pharmacy students. BMC Med Educ. 2012;12:120.CrossRefGoogle Scholar
  43. 43.
    Nguyen E, Chen TF, O’Reilly CL. Evaluating the impact of direct and indirect contact on the mental health stigma of pharmacy students. Soc Psychiatry Psychiatr Epidemiol. 2012;47:1087–98.CrossRefGoogle Scholar
  44. 44.
    Ott CA, McKee J. Mental health first aid as a skill set for community pharmacy personnel [internet]. 2015. Accessed 14 Feb 2018.
  45. 45.
    National Council for Behavioral Health. Mental health first aid [internet]. Accessed 14 Feb 2018.
  46. 46.
    Hinshaw SP. The mark of shame: stigma of MI and an agenda for change. New York: Oxford University Press; 2009. p. 202–16.Google Scholar
  47. 47.
    Whitley R, Berry S. Trends in newspaper coverage of MI in Canada: 2005–2010. Can J Psychiatry. 2013;58:107–12.CrossRefGoogle Scholar
  48. 48.
    Scheerder G, De Coster I, Van Audenhove C. Pharmacists’ role in depression care: a survey of attitudes, current practices, and barriers. Psychiatr Serv. 2008;59:1155–60.CrossRefGoogle Scholar
  49. 49.
    Mental Health Council of Australia. Mental health and quality use of medicines: report of the National Stakeholder Workshop concrete ideas for practical action [internet]. 2006. Accessed 14 Feb 2018.
  50. 50.
    Midwest Pharmacy Workforce Research Consortium. 2014 national pharmacist workforce survey [internet], Minneapolis. 2015. Accessed 14 Feb 2018.
  51. 51.
    Meterko M, Restuccia JD, Stolzmann K, Mohr D, Brennan C, Glasgow J, et al. Response rates, nonresponse bias, and data quality: results from a national survey of senior healthcare leaders. Public Opin Q. 2015;79:130–44.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Vincent Giannetti
    • 1
    Email author
  • Charles F. Caley
    • 2
  • Khalid M. Kamal
    • 1
  • Jordan R. Covvey
    • 1
  • Jerry McKee
    • 3
  • Barbara G. Wells
    • 4
  • Dean M. Najarian
    • 5
  • Tyler J. Dunn
    • 4
  • Pratyusha Vadagam
    • 6
  1. 1.Division of Pharmaceutical, Administrative and Social SciencesDuquesne University School of PharmacyPittsburghUSA
  2. 2.Department of Pharmacy PracticeWestern New England University College of Pharmacy and Health SciencesSpringfieldUSA
  3. 3.Community Care of North CarolinaRaleighUSA
  4. 4.The University of Mississippi School of PharmacyUniversityUSA
  5. 5.Janssen Scientific AffairsWrenthamUSA
  6. 6.Envision Pharma GroupNew YorkUSA

Personalised recommendations