Community pharmacists as a resource in task-shifted interventions for depression

Abstract

In Nigeria, mental health care is grossly underfunded and the psychiatrist to population ratio is less than 1:1 000 000.1Federal Ministry of Health Abuja NigeriaNational policy for mental health services delivery.http://cheld.org/wp-content/uploads/2015/02/national_policy_for_mental_health_service_delivery__2013_.pdfDate: 2013Date accessed: February 25, 2020Google Scholar Furthermore, almost all accessible mental health facilities are located in a few urban areas. As it will take decades to build an appropriate infrastructure and to expand the psychiatrist population in Nigeria, a more feasible remedy for alleviating the current mental health burden is to train non-specialist health-care personnel to provide mental health care. Current evidence suggests that primary care providers, lay health workers, or peer support workers can deliver effective evidence-based interventions for depression in low-income and middle-income countries including Nigeria.2Gureje O Oladeji BD Montgomery AA et al.Effect of a stepped-care intervention delivered by lay health workers on major depressive disorder among primary care patients in Nigeria (STEPCARE): a cluster-randomised controlled trial.Lancet Glob Health. 2019; 7: e951-e960Summary Full Text Full Text PDF PubMed Scopus (29) Google Scholar Although Nigerian policy identifies primary health care as the site for first-line health care, this premise often does not take place in reality because of the deplorable state of many primary health-care centres and their high costs.3Chinawa JM Factors militating against effective implementation of primary health care (PHC) system in Nigeria.Ann Trop Med Public Health. 2015; 8: 5-9Crossref Scopus (10) Google Scholar Nevertheless, Nigerians have easy access to community pharmacists with no added costs for registration, documentation, and consultation. Additionally, community pharmacies have long opening hours and shorter waiting periods than primary care centres, and no appointments are necessary to see a community pharmacist. For these reasons, community pharmacists are the first point of call for many individuals and at times the only health service with which some people make contact. Since at least 2015, Nigerian pharmacists have been reinventing themselves through value-added pharmacy services.4Osemene KP Erhun WO Evaluation of community pharmacists' involvement in public health activities in Nigeria.Braz J Pharm Sci. 2018; 54e17447Crossref Scopus (5) Google Scholar Community pharmacists in Nigeria might engage in sex education and health promotion and disease prevention activities, in addition to their core pharmacy activities. Thus, we wonder if community pharmacists would be able and willing to assess and treat depression with brief psychosocial interventions. An example of a relatively simple intervention that community pharmacists could be trained to deliver is behavioural activation therapy. Behavioural activation therapy assists individuals with depression in reconnecting with environmental sources of positive reinforcement and in decreasing avoidant and depressed behaviours. A large randomised controlled trial found that behavioural activation, when delivered by individuals without professional mental health qualifications or formal training in psychotherapy but who had received 5 days of training in behavioural activation, was just as effective at reducing depression as cognitive-behavioural therapy delivered by accredited cognitive-behavioural therapists with formal training who had also received 5 days of training.5Richards DA Ekers D McMillan D et al.Cost and Outcome of Behavioural Activation versus Cognitive Behavioural Therapy for Depression (COBRA): a randomised, controlled, non-inferiority trial.Lancet. 2016; 388: 871-880Summary Full Text Full Text PDF PubMed Scopus (304) Google Scholar Two-thirds of patients who received behavioural activation recovered from depression.5Richards DA Ekers D McMillan D et al.Cost and Outcome of Behavioural Activation versus Cognitive Behavioural Therapy for Depression (COBRA): a randomised, controlled, non-inferiority trial.Lancet. 2016; 388: 871-880Summary Full Text Full Text PDF PubMed Scopus (304) Google Scholar Moreover, behavioural activation generated better quality-adjusted life-years outcomes and was more cost-effective than cognitive-behavioural therapy, generating an incremental cost-effectiveness ratio of –£6865. Given the profound burden of depression and the shortage of mental health treatment in Nigeria, we urgently request that researchers follow the lead of Oye Gureje and colleagues2Gureje O Oladeji BD Montgomery AA et al.Effect of a stepped-care intervention delivered by lay health workers on major depressive disorder among primary care patients in Nigeria (STEPCARE): a cluster-randomised controlled trial.Lancet Glob Health. 2019; 7: e951-e960Summary Full Text Full Text PDF PubMed Scopus (29) Google Scholar and involve community pharmacists in the delivery of task-shifted interventions for depression and its co-occurring conditions. We declare no competing interests.