There is a quiet pattern anyone who has worked behind a pharmacy counter for any length of time can recognize. The patient showing signs of distress. The patient disclosing struggles with making ends meet in a new country. Or the patient asking questions about their medication in a way that suggests they may not be coping.
These encounters are not uncommon. Research has shown that as many as 86 per cent of community pharmacists interacted with at least one patient they perceived to be experiencing a mental health problem or crisis. Three-quarters have seen patients they believed were experiencing anxiety or depression. Thirty-eight per cent have encountered a patient they believed was experiencing suicidal thoughts.
But pharmacists are not trained to respond to these situations. And in a country with a mental health system as strained as Canada’s, that gap is more consequential than it sounds.
The good news is that the training exists. The evidence on whether this training works is good and getting better. And the place pharmacists occupy in the Canadian health-care system makes them the right people to receive it.
One of the training options is Mental Health First Aid (MHFA) – a two-day course that was developed in Australia in 2001 and has been delivered in Canada since 2007 through Opening Minds, a program of the Mental Health Commission of Canada. Anybody can take this course, which is structured around a simple premise: just as anyone can learn physical first aid to help in an emergency until professional help arrives, a person can learn to support someone experiencing a mental health crisis until appropriate help is reached.
The most pronounced impact of MHFA training on pharmacists is on their confidence to intervene, their likelihood to engage in conversations about mental health with patients and their likelihood to offer compassionate support. A pilot study we conducted, the first in Canada to evaluate MHFA training in pharmacy practice, found pharmacist confidence in assessing a patient for risk of suicide and harm rose from 46.7 per cent before training to 100 per cent after training. This can make a meaningful impact on individuals who may take few chances to voice they are struggling.
Patients themselves have voiced that pharmacists are part of how they manage their mental health. In our 2026 cross-sectional survey of 228 Canadian adults, we found that roughly one-third of respondents had met with their pharmacist about a mental health concern in the past month. Nearly 19 per cent had received help from a pharmacist related to suicide. Moreover, the proportion of Canadians who said they would be comfortable discussing mental health with a pharmacist rose from 53.5 per cent for an untrained pharmacist to 61.8 per cent for a trained one. Provincial regulators should include MHFA in contributing education requirements. Pharmacy schools should embed the certification in undergraduate training, as several Australian programs already do.
The not so positive news is that more training on its own will not be enough. Pharmacy is, by every measure, a profession under significant strain. Burnout among Canadian pharmacists has been climbing. Pharmacist associations across Canada have published reports calling attention to staffing models and corporate pressure to meet metrics that hurt the time for pharmacists to engage their full scope of practice. Asking a pharmacist who has been on her feet for nine hours, alone, with 12 prescriptions in queue and a phone ringing, to also conduct a careful suicide risk assessment in a patient consultation room is not a training problem. It is a structural one.
Large pharmacy chains, which now employ a substantial proportion of Canadian community pharmacists, have a direct role to play. Mandating meaningful pharmacist overlap during peak hours would change what is possible at the counter. It would allow one pharmacist to step away with a patient in distress while another continues dispensing safely. It would make the time and space that mental health conversations require possible when needed.
Pharmacists are by some measures the most frequently visited and most accessible health professionals in Canada. The average Canadian on regular medication sees their pharmacist every month. No appointment. No referral. No wait list. For patients whose mental health is deteriorating, the pharmacy counter may be the only health-care touchpoint in their life that month, and the pharmacist may be the only health professional in any position to notice.
This is true in ways that other health professions cannot quite replicate. We know who is on which medications, and we know when refills sometimes slip. We see the over-the-counter products that are being purchased alongside their prescription medications. In short, we see a different kind of clinical picture than what other health-care providers are able to see.
Universal MHFA training would not solve mental health care in Canada. It would not replace the family doctors, psychiatrists and counselors we do have, or the important services available. What it would do is make the most accessible health professional in the country competent at the first conversation, the one that decides whether someone leaves the pharmacy with a phone number and a sense of being seen or leaves with a quiet conviction that nobody noticed.
Funding for the two Canadian research studies was provided by the Canadian Foundation for Pharmacy and Bell Let’s Talk Community Grant
As always the solution involves proper staffing which is still not being addressed. We have to start at square one – staff the pharmacy appropriately. The more you keep adding, the more people burn out. We can’t be all things to everyone. This is not new. And no resilience course will fix it. New graduates are not choosing retail. We all know why.