Academic journal article American Journal of Pharmaceutical Education

An Elective Psychiatric Course to Reduce Pharmacy Students' Social Distance toward People with Severe Mental Illness

Academic journal article American Journal of Pharmaceutical Education

An Elective Psychiatric Course to Reduce Pharmacy Students' Social Distance toward People with Severe Mental Illness

Article excerpt


The general public has long held a negative attitude toward individuals with psychiatric illness, resulting in their stigmatization. (1-8) Although healthcare professionals are expected to be more understanding and exhibit less stigmatizing attitudes towards mentally ill patients, the literature suggests otherwise. Healthcare professionals also exhibit negative attitudes towards mental illnesses such as schizophrenia, and these negative attitudes are exacerbated when mentally ill patients have been hospitalized in a secured setting. (4,9,10) In some cases, patients maybe misdiagnosed or overdiagnosed because of clinician bias. (8)

Negative student attitudes can start early and are evident during training. A study of London medical doctors and students found that more than 50% perceived patients with schizophrenia as dangerous, unpredictable, and difficult to communicate with. (11) A survey of Australian nursing students showed that most held negative stereotypes towards mental illness. (12) Based on reactions to case descriptions, Nigerian medical students demonstrated that they were more likely to have negative attitudes towards patients with mental illness and to desire social distance. (13)

Social distance is "the relative willingness of one person to participate in relationships of varying degrees of intimacy with a person who has a stigmatized identity." (14,15) Emory S. Bogardus, a social scientist, developed the hypothesis that social attitudes could be described using a survey instrument and statistical analysis. (16) Although his original research focused on various ethnic and religious groups, the concept has been broadened to include other at risk populations such as those with psychiatric illnesses. (4,17)

Despite their varied geographic locations, pharmacy students in Australia, Belgium, Estonia, Finland, India, and Latvia exhibited similar degrees of social distance towards patients with schizophrenia. (18) Increased social distance by Estonian pharmacy students towards patients previously hospitalized for symptoms of schizophrenia was associated with poorer attitudes regarding medication counseling. (19) The literature is less clear on how to improve pharmacy students' social distance of patients with mental illness. A study conducted in Australia concluded that traditional methods of delivering mental health lectures and tutorials may not improve social distance of pharmacy students or pharmacy graduates toward individuals with schizophrenia and severe depression. (20)

The University of Maryland School of Pharmacy offers a 4-year full-time doctor of pharmacy (PharmD) program in which students enter with a minimum of 2 years of undergraduate coursework. Third-year PharmD students have the opportunity to enroll in a 2-credit didactic elective course, Perspectives of Mental Health. The purpose of this study was to evaluate whether an elective psychiatric course with outcomes designed to target stigmatization and dispel myths could reduce student social distance toward patients with severe mental illness. A secondary objective was to detect whether there were student characteristics that were more likely to be associated with social distance towards this patient population.


The elective was intended to provide students with an understanding of the mental health system, controversies that practicing pharmacist are likely to face, tools and techniques used in the treatment of psychiatric diseases, and the role of pharmacists in the provision of mental health care. The course learning outcomes are listed in Table 1. The learning outcomes that most specifically addressed negative attitudes and social distance included outcome 3, (evaluate the validity of commonly held notions and myths regarding mental illness and its treatment); outcome 4, (formulate and defend a position on a controversy related to mental health care); and outcome 8, (describe roles for pharmacists in the provision of mental health care services). …

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