What pharmacists can do for our mental health crisis

The Covid-19 pandemic highlighted weaknesses and strengths in New Zealand’s healthcare system. Community pharmacists emerged as one of its quiet powerhouses. When Level 4 restrictions hit in 2020 and many routine health services became inaccessible almost overnight, pharmacies stayed opened, adapting quickly and serving as a critical frontline for many communities.

Pharmacists responded to a significant increase in prescription demand when there were disrupted supply chains, keeping essential medication supplies and management services, keeping communities connected and delivering vaccination services when it mattered most.

This period offers profound insights into the capability of community pharmacists to pivot and support a public health system in crisis. As New Zealand confronts a deepening post-pandemic mental health crisis, a pressing question arises: can community pharmacists similarly help ensure there is prompt access to mental health support?

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We argue that community pharmacists are well-positioned to do so. According to the latest figures from the Pharmaceutical Society New Zealand, there are more than 1200 community pharmacies seeing about 1.3 million people each month in total. The very notion of community is embedded in the professional identity of community pharmacists; they are deeply integrated into the neighbourhoods and regions they serve.

Unlike many healthcare professionals who are concentrated in urban hospitals or clinics, community pharmacists are accessible far beyond the main centres, including rural and remote areas.

Pharmacists are often the most public-facing touchpoint in the healthcare system, providing a familiar and approachable setting. Pharmacists are funded to offer a range of physical health services for conditions such as diabetes, heart disease, hypertension, asthma, rheumatoid arthritis and chronic pain. They routinely inform and guide patients on medication use, adjust regimens, and monitor medication adherence.

Pharmacists are also able to provide ‘whole-of-life vaccinations’ from children to older adults and, increasingly, to supply prescription-only medication without a prescription to support better access, such as for Covid-19 antivirals and Hepatitis C medication. If pharmacists are already trusted with the management of these complex, physical health conditions, why not include mental health as a priority funded service?

Extending pharmacy services to mental health support would be a logical progression of the work community pharmacists already do. Their regular customers are often managing chronic health conditions that can be intertwined with mental health challenges. Physical illnesses such as diabetes, heart or respiratory disease often coexist with depression, anxiety, or insomnia, and treatment can be complicated by the interplay of physical and mental health symptoms. Pharmacists are therefore already well-positioned to help bridge the gap in current mental health service provision.

Pharmacists receive rigorous training in the safe and effective use of medicines. Their education covers not only the pharmacological properties and interactions of drugs but also the broader principles of medication management, adherence, and patient counselling.

This includes a focus on psychiatric medications – for example antidepressants, antipsychotics, mood stabilisers, and anxiolytics. Their ability to recognise and discuss potential side effects, monitor adherence, and identify risks, such as the dangers of abruptly stopping medication, is well-known.

In practice, this expertise could translate into a range of supportive actions for people with mental health needs: pharmacists could initiate conversations about medication experiences, help manage side-effects, encourage ongoing adherence, and act as a first point of contact for mental health concerns or questions, thereby helping to prevent complications or relapses.

Community pharmacists could also alert other clinicians such as general practitioners or specialist mental health services when more support may be needed. Pharmacists could also train to become pharmacist prescribers to support ongoing prescription of mental health medication in collaboration with a healthcare team.

Indeed, pharmacists are increasingly being recognised as key community health professionals, and their role is expanding rapidly. Recent initiatives, such as the Expanded Pharmacist Prescribing Programme, aim to boost access to care, especially in rural and underserved communities, but they also position pharmacists as frontline providers of medicines management, patient education, and collaborative care. This evolution is part of a broader effort to modernise and diversify the health workforce, reduce pressure on GPs, and improve patient access to prompt care. This move thus reinforces the potential of community pharmacists to provide physical and mental health care.

Research we and others have conducted in New Zealand with community pharmacists reveals enthusiasm about expanding their mental health role and interaction with customers. Many pharmacists see it as an opportunity to offer more mental health support as a natural extension of their commitment to holistic patient care.

Pharmacists recognise the trust placed in them by the public and are motivated to provide more comprehensive support in collaboration with other clinicians and disciplines. In New Zealand, community pharmacists have been found to have good mental health literacy in identifying conditions such as depression and have positive attitudes towards those with mental illness and are willing to provide mental health support.

If community pharmacists were involved in mental health care, it would lead to the early identification of mental health symptoms and improved continuity of care. It would also be professionally rewarding for pharmacists, enabling them to work to the top of their scope of practice.

However, pharmacists have also expressed concerns: the need for additional training, clear protocols, shared digital/electronic health record platforms, safeguards to manage the complexity of mental health needs and funded pathways to provide such services. Additionally, there are legitimate concerns about time and space constraints, the boundaries of their professional role, and the availability of referral pathways for patients requiring more intensive support. These perspectives underscore the importance of careful planning and resourcing for any expansion of pharmacist-led mental health services.

But this is achievable, and there are existing models of pharmacist-delivered mental health services, such as the Bloom programme in Canada. There are also social prescribing initiatives in the United Kingdom that involve community pharmacists together with other disciplines to provide support with health system navigation, harm reduction and person-centred care. In Australia, there are active trials evaluating the role of community pharmacies to provide physical and mental health support. In New Zealand, we will need more research and policy development to inform and guide effective models of care.

We hope to collaborate closely with the community pharmacy sector to co-design a practical programme to suit various settings and communities, with careful evaluation of outcomes for patients and pharmacists. Such a programme would aim to build on existing strengths so that mental health support is accessible at the grassroots level.

Community pharmacists are highly skilled and accessible healthcare professionals whose skills could be better deployed within the healthcare system.

Many are drawn to the profession to serve and engage with their communities. By equipping them with the right resources and training, there is real potential to help address both the mental health crisis and the pressures on our overloaded healthcare system, and where pharmacies can truly function as a key healthcare hub in the community.