Note to readers from APhA Executive Vice President and CEO Tom Menighan: I’ve invited William M. Ellis, BSPharm, MS, Board of Pharmacy Specialties (BPS) Executive Director, and Maria Llana Posey, PharmD, Board Certified Psychiatric Pharmacist and BPS Board Member, to contribute a guest blog post on suicide prevention. Suicide is something most of us don’t like to talk about, but most of us also have been affected sometime in our lives—and in every case, it’s tragic. Most suicides are preventable, and you, as a practicing pharmacist, may be in a position to help.

Pharmacist Patrick Tharp founded Pharmacists Preventing Suicides and worked to have legislation introduced in Missouri to help prevent suicides. At the same time, the news of the suicide of actor Robin Williams is making worldwide headlines. These stories, along with the ongoing efforts of the entire profession to gain provider status recognition for pharmacists, highlight an important role for the profession in managing medications for mental illness and identifying at-risk behavior for suicide.

The Mental Illness Research Association reports that 22% of Americans 18 years of age or older suffer from a diagnosable mental health disorder. Suicide ranks as the 10th leading cause of death in the United States, but there may be under-reporting due to the stigma associated with suicide, resulting in suicide ranking even higher as a cause of death. Suicides rank ahead of automobile accidents as a cause of death. Among teenagers and young adults, suicide is the third leading cause of death.

It is important to note that only 32% of the individuals who committed suicide had contact with a mental health professional, while 75% of these same individuals did have contact with a primary care provider. The accessibility of pharmacists is one of the great strengths of the profession and is a resource that should be recognized and utilized by our nation’s health care system.

In 2012, mental health medications represented the number two class of drugs in terms of spending, just behind oncology agents. A critical role for pharmacists is the provision of medication therapy management services. Certainly, the effective management of a therapeutic treatment for patients with depression should be included in that broad range of important service delivery.

Experts agree that many suicides can be prevented by looking at the various risk factors or signs that can be provided by patients. Some, but not all, of the warning signs associated with suicidal ideation include the following:

• Inability to handle stress
• Feelings of helpless and pain
• Withdrawal from family, friends, and pleasurable activities
• Sleep disorders (too much or too little sleep)
• Mood swings, including the expression of rage or anger or a sudden sense of calmness and order

A key factor for pharmacists to become aware of, through their relationship with their patients, is a previous suicide attempt or a direct verbalization of the patient’s desire to attempt suicide (including inquiries on how to commit suicide). The American Foundation for Suicide Prevention notes that 50% –75% of all people who attempt suicide tell someone about their intention.

Because of the important role that medications play in the management of mental illness, it is critical for pharmacists to utilize the point of contact they have to help optimize medication therapy outcomes and manage risks. Pharmacists can serve as a critical referral point for patients who are at significant risk of suicide, especially in cases where the patient has verbalized their intention. Pharmacists should be aware of local mental health services for referrals. National resources are also available, including at least two 24–7 hotlines:

• National Suicide Prevention Lifeline: 800-273-8255 (This hotline has a special service for veterans that can be reached by pressing “1.”)
• National Hopeline Network: 800-442-4673

Key positive findings from a 2012 patient and caregiver survey by the College of Psychiatric and Neurologic Pharmacists Foundation and the National Alliance on Mental Illness were the following:

• 91% of individuals taking mental health medications are very comfortable going to their community pharmacist.
• 83% felt respected by their community pharmacist.

However, the survey identified the following opportunities for improvement:

• 75% of individuals reported they did not receive effectiveness or safety monitoring assistance from their pharmacist.
• The primary concern from individuals taking mental health mediations is the lack of privacy to have a conversation with their pharmacist.

As pharmacists continue to pursue provider status at the national level and see the expansion of their services across the country and globally, it is important to realize that part of a comprehensive medication therapy management service includes a plan to help patients with mental illness maximize their therapeutic outcomes. With suicide taking the lives of nearly 30,000 Americans each year, managing mental illness and reducing the risk of suicide is an important opportunity for pharmacists as vital members of a healing profession whose services do save lives.

For additional information, pharmacists can refer to the American Foundation for Suicide Prevention at www.afsp.org, or Pharmacists Preventing Suicides at www.pharmacistspreventingsuicides.com.