To the Editor: Services provided by pharmacists are well-suited for optimizing the use of medications for mental illness.1 However, lack of mental health education is an important barrier to the provision of pharmacy services.2,3 Suboptimal attitudes toward people with mental illness are common among pharmacists and pharmacy students.4,5 There are few studies describing pharmacy education about depression, schizophrenia, and substance abuse. A recent study in the Journal reported the teaching of psychiatry-related topics at US colleges and schools of pharmacy.6 However, no corresponding studies have investigated mental health pharmacy education in Europe. With this in mind, we conducted a preliminary assessment of mental health pharmacy education provided at European universities.
A 20-item online survey instrument was developed using E-lomake software (Eduix Oy, Tampere, Finland). The survey instrument was adapted from survey instruments used to assess mental health pharmacy education at US colleges and schools of pharmacy,6 and depression education at medical schools in the Asia-Pacific region.7 The survey instrument was divided into 5 sections. Section 1 included 5 items about the respondents and their school of pharmacy. Section 2 included 6 items about the overall course content in relation to mental health. Section 3, 4, and 5 included 3 items each related to education about depression, schizophrenia, and substance use disorders. The survey and functionality of the E-lomake software was pilot tested for face-validity among a convenience sample of native and non-native English speaking educators.
The survey, cover letter, and participant information sheet were emailed to an academic staff member from 30 schools of pharmacy across Europe in December 2008. The pharmacy schools were a convenience sample but were selected to cover a range of sizes and country locations. All data were analyzed using the Statistical Package for the Social Sciences Version 15.0 (SPSS, Chicago, IL).
Responses were received from 16 pharmacy schools in Belgium, Denmark, Estonia, Finland, Latvia, Lithuania, Norway, Portugal, Slovenia, Spain, Turkey, and the United Kingdom (response rate 53%). Eleven of the respondents were lecturers or associate professors. Fourteen universities were publicly funded and 9 had an undergraduate student enrollment of more than 400 students. All universities taught psychiatry-related topics as part of a therapeutics-based course. Six universities employed or contracted a specialist mental health pharmacist to provide teaching, and 5 universities considered psychiatric pharmacy to be the content focus of their curriculum. All universities provided teaching about depression, schizophrenia, and substance use disorders via didactic lectures (Table 1). Two universities also provided the opportunity for students to participate in a psychiatric pharmacy clerkship to learn about depression and schizophrenia. Depression was taught for an average of 24 contact teaching hours per university degree. Schizophrenia and substance use disorders were taught for an average of 18 and 13 contact teaching hours per degree, respectively.
Table 1.
Number and Percentage of 16 European Universities Offering Various Formats of Education about Depression, Schizophrenia, and Substance Use Disorders
Our preliminary survey was the first to quantify the content, format, and duration of mental health pharmacy education provided at European universities. Our survey revealed considerable differences in mental health pharmacy education offered in Europe and the United States. Only 2 (13%) European universities that responded offered an elective internship in psychiatric pharmacy compared to 92% of universities in the United States.6 Only 6 (38%) European universities that responded employed or contracted a specialist mental health pharmacist to provide teaching, compared to 76% in the United States. These differences may be due to differences in mental health pharmacy practice in Europe and the United States. Pharmacists are able to undergo postgraduate specialization in mental health pharmacy in both the United States and United Kingdom, but not in most continental European countries. Despite these differences there were also several similarities. All of the responding universities in Europe and the United States offered psychiatric topics as part of a therapeutics-based course. In addition, no universities in Europe and only 4% of universities in the United States required students to undertake a psychiatric pharmacy internship.
Didactic lectures were the most common teaching method in relation to depression, schizophrenia, and substance use disorders. However, didactic lectures alone may not change students’ attitudes towards people with mental illness.8 Encouragingly, some universities combined didactic lectures with interactive education, including small-group tutorials, role-playing, problem-based learning (PBL), and having actual patients present about their experiences. PBL in medical education has been adopted at different rates across Europe.9 Our findings suggest that the same may be true of pharmacy education. Five universities included teaching about sufferer's experience of depression and schizophrenia, and 4 about sufferer's experience of substance use disorders. Having actual patients present about their experience may improve students’ attitudes toward people with mental illness.8,10 This format of education may also improve pharmacists’ confidence to provide services to people with mental illness.11
There are a number of methodological strengths and limitations to our study. We included universities from south, central, and northern Europe. However, the sample size of universities was relatively small. As with the US survey, it was possible that those universities with a research or teaching interest in mental health were more likely to respond. Determining the duration of contact teaching may have been difficult when material about depression, schizophrenia, or substance use disorders was taught as part of general courses on pharmacology, using patient case studies or during internships. In addition, our research did not assess the duration of non-contact teaching, nor the content, format, and duration of education provided at the postgraduate level.
In conclusion, there are considerable differences in the content, format, and duration of education provided in Europe and the United States. There is also considerable variation in mental health pharmacy education across Europe. There is a need to develop core competencies and minimum standards for the provision of mental health pharmacy education at the European and national levels. Our survey highlights the need for a larger European study to determine whether the education provided at European universities adequately prepares pharmacists to provide mental health care services.
Iiro Koskia
Asko Heikkila, BSc(Pharm)a
J Simon Bell, PhDa,b,c
aFaculty of Pharmacy, University of Helsinki, Finland
bKuopio Research Centre of Geriatric Care, University of Kuopio, Finland
cDepartment of Pharmacology and Toxicology, University of Kuopio, Finland
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