Dr. Talia Puzantian, Professor of Clinical Sciences for Keck Graduate Institute’s School of Pharmacy and Health Sciences (SPHS), recently received a four-year grant from the Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA), for $408,346. SAMHSA obtained this funding as part of the Bipartisan Safer Communities Act.

This landmark U.S. federal law was passed by Congress in June 2022, in the wake of the mass shootings in Buffalo, New York, and Uvalde, Texas. It funded new mental health and safety initiatives.

The goal of the funding specifically given to SAMHSA was to implement mental health awareness training to increase knowledge of mental conditions while reducing stigma, targeting different populations, including educators and first responders.

“I proposed to provide mental health awareness training to community pharmacists,” Puzantian said.

“Pharmacists are on every corner and get more visits on average than Starbucks. They’re accessible, trusted, and knowledgeable.”

However, pharmacists often lack training and confidence when it comes to helping those with mental health or substance use issues.

“By providing community pharmacists with this training, we could impact large segments of the population positively,” Puzantian said.

The SAMHSA grant will allow Puzantian to provide Mental Health First Aid (MHFA) training to Los Angeles County community pharmacists. MHFA teaches people how to recognize signs and symptoms of mental health and substance use concerns, provide an overview of common treatments and resources, and intervenes in a crisis.

Because people do not always communicate their feelings directly, pharmacists are trained to look for non-verbal signs that something is off, including changes in appearance and behavior. Additionally, pharmacists can see in their records if a patient has been using controlled substances in a potentially problematic way and can initiate a conversation, opening the door for that patient to seek treatment.

The training walks participants through a process called ALGEE: assessing whether the situation constitutes a crisis, listening non-judgmentally, giving reassurance and information, encouraging self-help, and encouraging appropriate professional help.

One doesn’t always use every step of this process. Knowing how to carry out these steps and when—for example—it would be appropriate to encourage professional help is covered in training.

“It’s a very hands-on training,” Puzantian said. “There are nearly 10,000 pharmacists licensed in L.A. County, working in various settings. Even if we train what I proposed, which is 500 pharmacists per year for the next four years, we’ll be able to reach a large percentage of the L.A. County community pharmacists who are working every day.”

Pharmacists have the opportunity to make a big impact not only because they see many individuals each day but people also feel very connected to their pharmacists. Puzantian recently witnessed this impact firsthand.

She was supervising pharmacy students in the Behavioral Health department of Adventist Health in Glendale, and they spoke with an 83-year-old woman who had just gone to a local pharmacy to pick up her prescriptions.

“She was faced with a much higher copay than she was used to, her rent had gone up, and her food expenses had gone up,” Puzantian said. “She was running out of money, and this was the last straw. She actually said, ‘I’m going to kill myself.’ And the pharmacist stepped in and got her help, sending her to the hospital.”

A large part of the training involves making appropriate referrals. A crisis intervention could involve sending the individual to a hospital or providing them with the new 988 number, a three-digit dialing code that will route callers to the National Suicide Prevention Lifeline, where trained counselors will listen empathetically and provide support.

In non-crisis situations, pharmacists can provide mental health resources, including the L.A. County Department of Mental Health and two local partners, Didi Hirsch and Pacific Clinics.

“Each of these community-based agencies has decades of experience in providing comprehensive behavioral health and substance use treatment and supportive services to children, adolescents, adults, and older adults throughout Los Angeles and beyond,” Puzantian said. “Services are provided in over 22 languages, are culturally and ethnically sensitive, and are responsive to the needs of marginalized and vulnerable populations.”

Pharmacists who undergo the training will wear a green pin that says, “Mental health matters”—encouraging patients to initiate a conversation—along with a QR code that links patients to these resources.

Although patients may not be ready to have a conversation with their pharmacist or seek help, they are at least made aware of resources.

“The average time to diagnosis for depression and anxiety is more than five years, and fewer than 20% of people with opioid use disorder get treatment, even though we know the treatments are very effective,” Puzantian said. “Anything we can do to increase those linkages can make a difference.”

The MHFA program involves a seven-hour commitment, with training sessions that will be available in person or virtually, but the pharmacists that Puzantian has trained so far outside of the grant have been very receptive to and grateful for the training.

“They feel that it’s very practical and something they will put to good use,” Puzantian said.

Not only will they receive certification by the National Council for Wellbeing—the organization that oversees MHFA—at no cost, but they will also receive continuing education credits, a requirement for remaining an active licensed pharmacist. These credits are offered through a partnership Puzantian formed with the American Association of Psychiatric Pharmacists.

“I specifically chose Mental Health First Aid training and certification because it’s an evidence-based program that’s been in the U.S. since 2008, and nearly three million Americans have already been trained,” Puzantian said. “And the evidence shows that it decreases stigma, increases knowledge, and increases confidence in helping struggling people.”

For more information on this initiative, please visit kgi.edu/mhfa.

Below is a list of resources mentioned in this article:

  • Mental Health First Aid: mentalhealthfirstaid.org
  • American Association of Psychiatric Pharmacists (AAPP) – provider of continuing education credits for pharmacists who complete the MHFA training, as well as additional resources for pharmacists interested in mental health and substance use: aapp.org

Local partners with whom trained pharmacists can make linkages for people in the communities they serve when a need for assessment and treatment is identified: