title: From personal crisis care to convenience shopping: an interpretive description of the experiences of people with mental illness and addictions in community pharmacies.
abstract: The role of community pharmacists is changing globally with pharmacists engaging in more clinically-oriented roles, including in mental health care. Pharmacists' interventions have been shown to improve mental health related outcomes but various barriers can limit pharmacists in their care of patients. We aimed to explore the experiences of people with lived experience of mental illness and addictions in community pharmacies to generate findings to inform practice improvements.
  
  
  
  We used interpretive description methodology with analytic procedures of thematic analysis to explore the experiences of people with lived experience of mental illness and addictions with community pharmacy services. Participants were recruited through multiple mechanisms (e.g., paper and online advertisements), offered honorarium for their time, and given the option of a focus group or interview for participation in our study. Data were gathered during July to September of 2012. Interviews and focus groups were audio-recorded, transcribed verbatim, and analyzed by two researchers.
  
  
  
  We collected approximately nine hours of audio data from 18 individuals in two focus groups (n = 12) and six individual interviews. Fourteen participants were female and the average age was 41 years (range 24 to 57 years). Expectations, decision-making, and supports were identified as central themes underlying the community pharmacy experiences of people with lived experience of mental illness and addictions. Eight subthemes were identified including: relationships with pharmacy staff; patient's role in the pharmacist-patient relationship; crisis and triage; privacy and confidentiality; time; stigma and judgment; medication-related and other services; and transparency.
  
  
  
  People with lived experience of mental illness and addictions demonstrate a high regard and respect for pharmacist's knowledge and abilities but hold conservative expectations of pharmacy health services shaped by experience, observations, and assumptions. To some extent, expectation management occurs with the recognition of the demands on pharmacists and constraints inherent to community pharmacy practice. Relationships with pharmacy staff are critical to people with lived experience and influence their decision-making. Research in the area of pharmacists' roles in crises and triage, especially in the area of suicide assessment and mitigation, is needed urgently.
authors.affiliation: College of Pharmacy and Department of Psychiatry, Dalhousie University, 5968 College St., PO Box 15000, Halifax, NS, B3H 4R2, Canada. andrea.murphy@dal.ca.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Murphy
authors.affiliation: School of Nursing, Dalhousie University, 5869 University Ave., PO Box 15000, Halifax, NS, B3H 4R2, Canada.
authors.forename: Ruth
authors.initials: R
authors.lastname: Martin-Misener
authors.affiliation: Sun Life Financial Chair in Adolescent Mental Health, Dalhousie University/IWK Health Centre, 5850 University Ave., PO Box 9700, Halifax, NS, B3K 6R8, Canada.
authors.forename: Stan P
authors.initials: SP
authors.lastname: Kutcher
authors.affiliation: Faculty of Pharmacy, University of Sydney, Pharmacy and Bank Building (A15), Camperdown Campus, The University of Sydney, Sydney, NSW, 2006, Australia.
authors.forename: Claire L
authors.initials: CL
authors.lastname: O'Reilly
authors.affiliation: Faculty of Pharmacy, University of Sydney, Pharmacy and Bank Building (A15), Camperdown Campus, The University of Sydney, Sydney, NSW, 2006, Australia.
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Chen
authors.affiliation: Department of Psychiatry and College of Pharmacy, Dalhousie University, QEII HSC, AJLB 7517, 5909 Veterans' Memorial Lane, Halifax, NS, B3H 2E2, Canada.
authors.forename: David M
authors.initials: DM
authors.lastname: Gardner
mesh_terms: D000328:Adult; D003157:Community Pharmacy Services / Q000458:organization & administration; D003657:Decision Making; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D001523:Mental Disorders; D008875:Middle Aged; D010595:Pharmacists; D024382:Professional Role; D011369:Professional-Patient Relations; D012648:Self Care; D019966:Substance-Related Disorders
keywords: Decision making; Mental disorders; Patient preference; Pharmacy; Qualitative research; Suicide