Mental Health In The Pharmacy: What We Aren’t Taught

mental health in the pharmacy

Mental health. It’s always a trending topic, always at the forefront of our agendas in 2021. But why does it feel surprising when we hear that someone has had a breakdown, or that they’ve had to take time off from work for a ‘mental health’ day?

In my day job as a pharmacist, I meet all kinds of patients. People with lives in between the medicines they use, with smiles and tears, triumphs and fears.

On this typical day, someone wants to speak to the pharmacist. Inside the consultation room, I sit down with the lady in question and let her talk. When I had handed out her prescription a few moments earlier, she could have been anyone.

Now I look at her as she speaks, with dark eyes, wide and watery, and a reddish tinge to her skin. Her hands shake as she places one on the table, a silver bracelet dangling from her slim wrist.

“I’ve got anxiety. I’ve just been to A&E because I had a breakdown.”

There are so many other things that need my attention outside this little room but I put them at the bottom of the list.

“I’ve got two little kids. I do talking therapy, and I’m getting couples therapy with my husband. But I don’t want to destroy my life just because I can’t get it together.”

I know I won’t be able to help her. But I let her speak, watching as her eyes become more tearful. Her mouth pulls into a nervous smile as she stutters to get her words out. My thoughts run through possible solutions, but she’s already exhausted them.

So, I let her take up my time. And this small space—these few minutes where she has my attention—becomes a sort of shelter for her. It seems like she needs it.

I want to tell her that she isn’t alone, that many people struggle just like her. That she isn’t the only one going through this awful problem. In the end, I give her what advice I can and add, “Sorry I couldn’t be much help, but if you ever need to talk to someone, we’re right here.”

Rewind a month back. It’s a quiet morning and my sleepy mind is precariously propped up by caffeine. I hand out a prescription of antibiotics—nothing unusual, take one tablet four times a day, on an empty stomach—and the patient wishes to speak to me. Before she can say anything else, I catch the look in her eye, the twitch in the corner of her lips.

We sit in private.

“I don’t agree with the doctor’s diagnosis, could you take a look for me?”

She tells me how she refuses to take these antibiotics. How she really doesn’t like taking tablets. How she suffers from chronic back pain but restricts the number of strong painkillers she takes.

This was a woman who was in control of her life. But this strong woman, with clear, dark skin and hair tied up in neat a bun, held a tissue to her eyes, constantly wiping away tears. Tears that she wished weren’t there—in front of me, a stranger—but defiantly trickled from her eyes.

Her mother had died from complications which she pinned down to inappropriate medication use. I understand her perception now, but it’s more than that. It’s not just about taking medication. It’s that she felt no one was truly listening to her. So I let her talk.

Image that says: It's not just about taking medication. It's that she felt no one was truly listening to her. So I let her talk.

Let’s go back another few weeks.

It’s the same pharmacy and I honestly can’t remember the details of that afternoon. You know when all the days just blur into one? An older gentleman pops in to speak to me.

We sit down in the consultation room and he takes his hat off, wiping his brow. His face is pink from the raging heatwave outside.

“My partner’s not been feeling well recently.”

This was definitely beyond my scope (can you see a pattern here?). He tells me how he thinks his partner’s depression is back. She’s stayed at home in her room for days and doesn’t want to leave. The curtains are closed. She’s not speaking to anyone.

“She hasn’t been like this for years.” He doesn’t cry as he fiddles with his hat, but the worry painted on his face couldn’t have been plainer.

I don’t have a clue what to say. But from whatever small piece of advice I could give, he nods at the words. Smiling. Shoulders relaxing.

“Right, that’s what I thought. Just wanted to get a second opinion.”

Have I done something right? I think as he stands up and goes to shake my hand. He looks genuinely happy, like a weight has been lifted off his shoulders. Now, filled with confidence, he could face the problems of the ones he loved and cared for.

The Hidden Side of Healthcare

I wasn’t prepared for this. Nowhere in my five-year training was I taught that I’d be consoling patients with problems bigger than my own. That I’d need to hold space for people’s vulnerabilities.

At the time, I was a newly qualified pharmacist. I remember being shocked at the number of patients prescribed medication for various mental health conditions. Perhaps I was being naive, but I was also a product of my education. Mental health was rarely a topic brought up at school or university.

I had always thought the speciality of psychiatry was separate from the other parts of healthcare. As a student, I loved learning about all the different systems of the body, but the nervous system was a special enigma. It felt shrouded in mystery, and by extension, mental health seemed like the elusive unicorn of illness and disease.

We were never taught how common poor mental health was, or perhaps I wasn’t listening closely enough.

As newly qualified pharmacists, we sometimes had the opportunity to discuss these matters with a tutor or supervisor, a mentor to guide us through the realities of professional life. But those meetings are usually focused on the technicalities of medicines management, guidelines and SMART objectives.

I didn’t know who to speak to about this gap in my experience. So I turned inwards and looked at myself.

When it comes to personal problems, I always need to talk them out to figure out a solution. I’ve found talking through it (and no, not always to myself!) to be a good way of keeping sane. Even if the other person doesn’t offer any true solutions, the actual act of speaking can alleviate my worries.

Then, there came a time in my life where I found myself not having this. Or, at least, I told myself I didn’t have this. I felt like I didn’t have people that I could vent to, which made me a more closed off person. These thoughts seem strange to me now, as someone grateful to have a wonderful support network.

Back then, however, I thought the safest way to (emotionally) survive life was to only look out for yourself. You had to be selfish to be happy. I spiralled into a phase that left me empty inside, yet heavy at the same time. And a lot of the time, I felt extremely lonely.

Loneliness. It’s not about not having weekend plans (I do love a weekend where I can laze about the house). It’s a gnawing sensation. A kind of heavy hollowness.

It’s knowing that you have a hundred and one things in your mind and not a single person to unravel your thoughts with. That weight, this heavy emptiness, bears down on you. It comes and goes, shrinking and swelling; a balloon filled with rocks.

As always, social media doesn’t help either. We all know this, but we still swipe through countless highlights of other people’s days. It feeds that bleak void and ironically makes it heavier.

We live on a planet saturated with people, so we’re not meant to be alone. It’s the complete opposite of our nature, no matter how introverted you are.

It makes sense that we forge and create meaningful connections with each other.

I’ve always told myself that looking out for ‘me, myself, and I’ is the safest way to endure life, but that’s not how to survive in this world. Not if you want your soul to be wholesome.

Loneliness is an uncomfortable part of life because you’re not meant to shoulder your burdens like this. An individual can only take so much, and research shows how chronic loneliness can harm your health.

It’s okay to find yourself crying on someone else’s shoulders. It’s perfectly acceptable to not feel strong. And it’s completely normal to find someone else unloading on you. Let them.

Image that says: Give them a safe space--even a sanctuary of five minutes--to talk and talk and talk until all they find themselves talking about are silly things.

Our fragility feeds into the resilience we develop. Though we might want others to see us as ‘strong’, we are all fragile. Others are better at holding up their guard, but at the kernel of every soul is something beautifully delicate. Something that needs to be cultivated with love, in all its vast shades of meaning.

A kind word can go a very, very long way. You may never know the beautiful ripple effect of your words and actions that can lift someone’s spirit.

It makes sense that patients unload their problems on healthcare professionals. Sometimes they don’t have anyone else to talk to, or they don’t want others to know that they feel so alone. A nurse taking their blood or a pharmacist behind the counter might just be their last resort.

As healthcare professionals, mental health training should be embedded into our curriculum. Not just as a tick-box exercise, but to instil a real, empathetic understanding of our society and its hidden problems.

I have no idea if my chat with the lady who felt anxious helped her at all.

Or if the other lady had taken those antibiotics as prescribed.

Or if that gentleman’s partner got the help she needed.

At the very least, I hope they were strengthened for the next twenty-four hours that they needed to face.

First published in Reclamation Magazine as ‘Five Minute Sanctuaries’, 2018