Opening the Gate for Student Mental Health Needs

From the September 15, 2023 issue of the Transformational Times

Opening the Gate for Student Mental Health Needs

Kevin Bozymski, PharmD, BCPS, BCPP

Dr. Bozymski, a board-certified psychiatric pharmacist, discusses the mental health stressors faced by health care students, and shares his journey of training future pharmacists to become mental health “gatekeepers” for their peers (and themselves) …

Expanding beyond algorithms

When people ask me what I do for a living, it’s not as straightforward as saying teacher or pharmacist—or even the phrase, mental health pharmacist. It usually involves a back-and-forth dialogue, with me imperfectly describing my winding path as the audience inquires, prompts and clarifies. Upon reflection, the emphasis on one-on-one connections is what got me on my path. 

While healthcare practitioners and researchers value the scientific method (me included), I’ve often found algorithms too restrictive. That’s why psychiatry resonated with me as a student pharmacist, where the right pharmacologic choice cannot be made without considering an individual’s preferences, values, and environment.

It’s also why academia called to me as a resident pharmacist, where a “one-size- fits-all” teaching approach does not meet every learner’s preference, needs, and background. 

Unfortunately, it’s easy to fall into the algorithm trap as a teacher when discussing student mental health, especially when we aren’t taking care of our own mental health. We look back in our own life to how we handled stress as a learner, assuming our experience will translate well to another’s. We worry about finding time to dialogue, looking toward rating scales used in clinic appointments as a model for triaging student concerns. This solutions-first mindset shows in our health care learners, as a recent scoping review of medical student literature found fears of decreased career opportunities, nonconfidentiality and personal stigma as the top individual barriers to care.

Before walking in someone else’s shoes, it’s worth asking about their journey so far and how they find themselves now. 

From stress to burnout to on fire 

As the psychiatric pharmacist on faculty within Medical College of Wisconsin School of Pharmacy, I am invited to give perspective about student mental health on many interdisciplinary councils, committees and workgroups. The most impactful discussions, though, come in one-on-one discussions with my student pharmacist mentees. 

These quarterly meetings have a brief agenda,  and are open-ended for me to actively listen and ask: How is your quarterly session going? What has been a surprise since we last spoke? Where do you want your shoes to take you, and how can I help them do so?

It's no secret that the MCW PharmD curriculum is stressful, with students completing four years of traditional coursework in just three. And while it’s unclear to what extent stress correlates to burnout and mental health concerns, published U.S. student pharmacist surveys identify positive response rates of 19% to 40% for clinical depression (via PHQ-9) and 21% to 41% for clinical anxiety (via GAD-7). (see references 2-5)

Furthermore, the American Academy of Colleges of Pharmacy has released a statement encouraging pharmacy schools to proactively promote overall wellness and stress management techniques.

There’s no easy algorithm to determine who develops clinically significant concerns, but it is near-impossible to do so unless a student is connected enough to their academic community to be asked.

Who’s at the gate for mental health care?

Access and stigma are two driving barriers in psychiatry, and certainly student mental health is no exception. Therefore, gatekeeper training—programs teaching how to identify warning signs of mental crises and connect people to needed services—have been spreading across the globe. Such programs are not just for healthcare practitioners, but for anyone with a desire to improve mental health in their area. Thanks to funding from the Kern Institute, the MCW Pharmacy School, and Advancing a Healthier Wisconsin endowment, I’ve had the honor as a certified Mental Health First Aid instructor of teaching 60 first-year PharmD students (so far) how to open the gate for their peers, their communities, and themselves.

While students over the years have commented on its benefits, one anonymous comment from a course evaluation struck me the most:

“These skills were amazing to learn. It has helped with not only my family and friends but also has been used in practice with my peers. To have the ability to learn about what people go through and how to be able to approach and talk to people about a mental health crisis is something everyone should learn.”

If we cannot break down every systematic gate standing between an individual and mental health resources, we can at least ensure the keepers know how to help passersby. And even if my student pharmacist self from over a decade ago does not fully understand the unique stressors of this generation, I can at least dedicate myself to learning from and conversing with them in a non-algorithmic way - using the information gained to better appreciate, reassure, and connect.

After all, with mental health, an imperfect response is better than no response at all.

Take action:

Interested in becoming trained as a MHFA instructor (or just completing MHFA certification yourself)? Please contact Dr. Kevin Bozymski or Dr. Himanshu Agrawal for more information. 

For further reading:

1. Berliant M et al. Barriers faced by medical students in seeking mental healthcare: a scoping review. MedEdPublish (2016). 2022; 12:70.

2. Koutsimani P et al. The relationship between burnout, depression, and anxiety: a systematic review and meta-analysis. Front Psychol. 2019; 10:284.

3. Fischbein R et al. Pharmacy and medical students’ mental health symptoms, experiences, attitudes, and help-seeking behaviors. Am J Pharm Educ. 2019;83(10):7558.

4. DeHart RM et al. Prevalence of depression and anxiety among student pharmacists. Int J Med Pharm. 2020;8(2):1-8.

5. Shangraw AM et al. Prevalence of anxiety and depressive symptoms among pharmacy students. Am J Pharm Educ. 2021;85(2):8166.

6. American Colleges of Clinical Pharmacy. AACP Statement on Commitment to Clinician Well-Being and Resilience. Accessed https://www.aacp.org/article/commitment-clinician-well-being-and-resilience on September 5, 2023.

7. Suicide Prevention Resource Center. Choosing A Suicide Prevention Gatekeeper Training Program: A Comparison Table. Accessed https://sprc.org/wp-content/uploads/2022/12/GatekeeperMatrix6-21-18_0.pdf on September 5, 2023.

8. National Council for Mental Wellbeing. About MHFA: What is Mental Health First Aid? Accessed https://www.mentalhealthfirstaid.org/about on September 5, 2023.

Dr. Kevin Bozymski, PharmD, is an Assistant Professor with appointments in the MCW Pharmacy School Department of Clinical Sciences and the School of Medicine Department of Psychiatry & Behavioral Medicine. He is a certified Mental Health First Aid instructor, providing training through an Advancing a Healthier Wisconsin endowment. He also provides clinical services at both the MCW Tosa Health Center and Froedtert Hospital Complex Intervention Unit.