An evaluation of pharmacy undergraduate clinical placements in a UK mental health and learning disabilities trust 

All undergraduate pharmacy degrees in the UK must meet standards set out by the General Pharmaceutical Council (GPhC) and this includes the provision of experiential learning in pharmacy settings​[1,2]​. Providing high-quality experiential learning in mental health settings can contribute towards reduced stigma, enable parity of esteem and prepare future pharmacists to be aware of the specific needs and health inequalities faced by people with mental illness or a learning disability​[3–5]​. Despite these benefits, the evidence suggests that mental health learning outcomes at undergraduate level are largely theoretical, with a lack of practical application​[6]​.

In response, the University of Hertfordshire and Hertfordshire Partnership University NHS Foundation Trust (HPFT) were awarded a Health Education England grant to assess the feasibility of incorporating clinical placements in a specialist mental health and learning disability setting into the pharmacy undergraduate curriculum.  

The aim of the project was to assess the feasibility of undergraduate clinical placements in a specialist mental health and learning disability setting. The objectives were to: 

• Understand the factors that contribute to a successful undergraduate clinical placement in a specialist mental health and learning disability setting;
• Identify the impact on the undergraduate pharmacists when introduced to a specialist mental health and learning disability setting; 
• Understand the impact on pharmacy staff when delivering undergraduate clinical placements in a specialist mental health and learning disability setting.

Funding was available for 30 students and, despite an initial recruitment of 22 students, a final number of 13 year 3 and year 4 pharmacy undergraduates participated in a one-week placement at HPFT. The main reason for students not taking up their placements was a lack of public transport to the placement site.  

The placement was structured around a customised workbook adapted from a version initially developed for acute hospital placements. Following the completion of mandatory safety training, the students had opportunities to interact with different multidisciplinary team members within the care setting and service-users, under supervision.  

A significant effort was made by the HPFT pharmacy team to expose students to a range of activities, such as participating in care planning meetings with nursing staff, liaising with doctors and pharmacists about high-risk medicines (e.g. clozapine and lithium), participating in a guided tour of the electroconvulsive therapy (ECT) suite, shadowing community nurses in depot and clozapine clinics, meeting with psychologists and occupational therapists, and learning from the Mental Health Act staff.  

The data collection tools were designed to identify:  

• Changes in mental health knowledge pre- and post-placement;  
• Student self-evaluation of their competencies pre- and post-placement;  
• Student and HPFT staff experiences post-placement.  

All 13 students participated in data collection. Quantitative pre- and post-placement questionnaire data were compared using paired t-tests. Their mean MCQ scores increased from 4.85 to 6.85 out of 15, demonstrating a significant improvement (t [12] = 2.7255, p<0.05). However, the scores pre- and post-placement were still relatively low.  

 Pre- and post-placement self-evaluations also showed statistically significant improvements in the mean scores per student: 3.12–3.80 out of 5 (t [12] = 4.6, p<0.001). The results indicated an overall positive shift in student knowledge and in their own evaluations of competence and confidence.  

 There are plans to obtain a greater understanding of enablers and barriers to a successful placement in a mental health and learning disability setting through qualitative data analysis of free-text student and facilitator feedback. Anecdotally, the data is overwhelmingly positive with feedback in response to what the students found most valuable:  

“Increased knowledge on mental health, learnt more about antipsychotics and MH law and really enjoyed the depot clinic, seeing pharmacists in action.”

“The staff and the rest of team were so accommodating, engaging and eager to help the students learn.”

Facilitator feedback was also encouraging when asked what they felt worked well during the placements:  

“The trainees really engaged with the session and seemed interested to learn.”  

“The students were able to observe the wards and dispensary, so their experience was quite varied.  Also, the groups were split up, so some were in dispensary and some on wards and this worked well as we were able to teach the students in smaller groups.”  

The pilot study has demonstrated promising outcomes for including mental health and learning disability placements within the pharmacy undergraduate curriculum, with clear improvements recorded in student scores post-placement. However, it should also be noted that the scores pre- and post-placement were still relatively low. Results from a study carried out by researchers from the University of Huddersfield and published earlier in 2023 show there to be a lack of mental health knowledge among qualified pharmacists and pharmacy undergraduates​[7]​. This raises questions for pharmacy educators, curriculum planners and the wider profession as to whether mental health and learning disabilities currently receive sufficient prominence within the MPharm curriculum and is certainly a subject worthy of further investigation and research.  

Gurdeep K Major, project pharmacist; Anjli Vij, specialist clinical pharmacist; Seema Vekaria, lead clinical pharmacist; Chetan Shah, former chief pharmacist; Tim Gale, research lead, all at Hertfordshire Partnership University NHS Foundation Trust; and Hershel Joshi, principal lecturer in experiential education at the University of Hertfordshire