Talking it over
The latest data from the NHS shows an increase in referrals to talking therapies, as well as a rise in recovery rates for people experiencing anxiety and depression. How can pharmacy teams help customers spot the symptoms and access the help they need?
It’s estimated that a staggering one in four people in the UK experience a mental health problem each year, according to the mental health charity Mind, with anxiety and depression two of the most common forms. These can take a massive toll on a person’s life and make even the smallest day-to-day tasks challenging.
Thankfully, it seems more people than ever are seeking help with their mental health, with new statistics from NHS Digital revealing that 1.6 million referrals were made to talking therapies for anxiety and depression in England during 2018-19, up 11.4 per cent from the 1.44 million the previous year.
What’s more, 89.4 per cent of people waited fewer than six weeks for their first treatment appointment – up from 89.1 per cent in 2017-18 – and 99.0 per cent waited no more than 18 weeks to start their treatment – up from 98.8 per cent in 2017-18.
Recovery rates have also gradually increased since data collection began in 2012-13, with 52.1 per cent of courses of treatment ending in a person’s recovery in 2018-19, up from 50.8 per cent in 2017-18. The report also showed that the more sessions a person attended the better, with those making it to an average of 7.6 appointments more likely to move towards to recovery.
But how common?
Around one in six people in England report experiencing a common mental health problem in any given week, according to Mind.
Every seven years the charity carries out a survey to measure the number of people who have different types of mental health problems. The latest figures from 2016 show the most common forms of mental health problems are:
- Mixed anxiety and depression – present in 7.8 in 100 people
- Generalised anxiety disorder – 5.9 in 100 people
- Post-traumatic stress disorder (PTSD) – 4.4 in 100 people
- Depression – 3.3 in 100 people.
And while the overall number of people with mental health problems has not changed significantly in recent years, the charity says increasing worries about things like money, jobs and benefits can make it harder for people to cope when things feel difficult. In fact, its data suggests that how people cope with mental health problems is getting worse, as the number of people who self-harm or have suicidal thoughts is increasing. Mind’s survey of the number of people who have self-harmed, had suicidal thoughts or have made suicidal attempts over their lifetime reports that 20.6 in 100 people say they have had suicidal thoughts, 7.3 in 100 people admit to self-harming and 6.7 in 100 people have made suicide attempts.
One in four people in the UK experience a mental health problem each year
Nonetheless, with referrals to talking therapies on the rise, it is clear that some people are finding their way to these as a helpful way to tackle issues.
There are many different types of talking therapies available, so it’s a good idea for pharmacy staff to know a bit about them so information can be passed onto customers. The first thing to note is that talking therapies can differ in their focus. Some are based around helping the person learn more about themselves by talking about their past, whereas others aim to give them the tools to unpick or overcome a specific problem they may have in the present moment.
For example, some of the most widely used talking therapies include:
- Cognitive Behavioural Therapy (CBT): explores a person’s thoughts and the way they think
- Mindfulness-based therapy: involves becoming aware of current thoughts and feelings and accepting them, often involving mindfulness techniques such as meditation and breathing exercises
- Person-centred therapy: focuses on using a person’s own strengths and insight about themselves to encourage personal growth and improve relationships
- Psychoanalytic (or analytic) therapy: focuses on unconscious, deep-rooted thoughts that often stem from childhood
- Psychodynamic (or dynamic) therapy: explores how unconscious thoughts might affect the way someone acts
- Solution-focused therapy: focuses on what an individual wants to achieve in the future rather than exploring past experiences.
Support and signposting
As with so many conditions that present themselves in community pharmacy, staff are ideally placed to recognise mental health issues in customers – even before they do so themselves – as a result of OTC requests for things like sleeping aids or alternative remedies for low mood.
Pharmacy staff might recognise the signs in those they see regularly because they appear to be unusually unhappy or don’t engage in conversation like they normally do. Simply asking them how they feel or even saying, “I’m concerned that you don’t seem yourself at the moment – are things OK?” could be the kind of interaction they need to speak to someone about how they are.
Mental Health First Aid training (mhfaengland.org) is another tool that can help pharmacy teams recognise and work effectively with people who are experiencing mental health issues. This includes how to spot some of the soft signs people may exhibit, such as presenting with physical health symptoms rather than being initially open about mental health issues.
Once a conversation has been started, there is a lot that can be done to point customers on the road to recovery. The best place for them to begin is by speaking to their GP, who will be able to help them access talking therapies, and prescribe any appropriate and necessary medication. For example, in England, the NHS’ Improving Access to Psychological Therapies (IAPT) programme provides treatment services including talking therapies for depression and a range of anxiety disorders such as agoraphobia, post-traumatic stress disorder, obsessive-compulsive disorders, panic disorders and social phobias.
However, it’s important to be aware that not all therapies are available everywhere as it may depend on what is on offer locally. Those who can afford it can also seek out private therapists. Mind has useful information on how customers can find a private therapist, available by searching their website, or they can be encouraged to talk to their occupational health adviser at work if they have one.
Pharmacy teams have a long tradition of being very good at sharing information about physical health conditions, and with community pharmacies being so accessible thanks to long opening hours and often being based in the heart of the community, the important impact pharmacies can have in helping customers protect their mental health should not be underestimated.
More often than not it is pharmacy support staff who really know their customers best, and for some of the most vulnerable people, a conversation might be the only contact with another person that they have in a given week. Everyone has a part to play when it comes to normalising conversations about mental health, and the simple act of recognising that someone might be struggling, asking them how they are feeling, being ready to listen in a non-judgemental way, and able to signpost them to sources of support, could change their life – and may even save it.
Stress and depression among adult carers in the UK
A new report from NHS Digital – Personal Social Services Survey of Adult Carers in England 2018-19 – shows an increase in adult carers feeling stressed or depressed. Some 60.6 per cent of carers reported feeling stressed in 2018-19, up from 58.7 per cent in 2016-17, and the percentage of carers who reported feeling depressed increased from 43.4 per cent to 45.1 per cent.
More than three quarters of the 50,800 carers surveyed (76 per cent) said that they spend over 20 hours per week looking after the cared-for person, with 38.7 per cent spending over 100 hours per week on their caring duties. Some 77.8 per cent reported feeling tired – an increase from 76.0 per cent in 2016-17 – and 66.0 per cent said that they experienced disturbed sleep, which had increased from 64.0 per cent the year before.
The biennial survey also provides vital information about the impact of people’s caring responsibilities on their quality of life. The results showed the percentage of carers who were not in paid work because of their caring responsibilities increased from 21.0 per cent in 2016-17 to 22.6 per cent in 2018-19, with a knock-on effect that 10.6 per cent of respondents reported that caring had caused them a lot of financial difficulties in the past 12 months – an increase from 2016-17, when the figure was 9.6 per cent.
The report also provides information relating to the carer and their wider experiences of providing care:
- The majority of carers were female (67.8 per cent)
- The largest age band of carers was 55-64 years, which accounted for 23.8 per cent of the eligible population. The smallest group, 18-24 years, accounted for 1.6 per cent of the eligible population
- The majority of carers surveyed (65.4 per cent) have been carers for over five years and almost a quarter (23.5 per cent) have been caring for 20 years or more
- Most carers who responded to the survey were caring for a person with a physical disability (51.4 per cent), with the next-largest group caring for someone with a long-standing illness (39.7 per cent).
As with all customers, pharmacy teams can be on the look out for signs of mental health problems in carers and be on hand with appropriate advice, support and signposting.
- Mind has a useful online tool to help people understand and manage their mental health when they feel like they might need support.
- The British Association for Counselling and Psychotherapy (BACP) website has an extensive A–Z of therapeutic approaches. This list covers many types of therapy by name, and explains the different beliefs and approaches behind each one.
- Anxiety UK national anxiety helpline: 03444 775 774.
- Rethink Mental Illness factsheets.