UB study reveals shift in pharmacy students’ perceptions of patients with mental illness

BUFFALO, N.Y. ­– Tammie Lee Demler, PharmD, a board-certified psychiatric pharmacist who works at a Buffalo inpatient psychiatric practice site, is all too familiar with the stigmas and misconceptions facing people with mental illness. And it’s an issue she’s doing her part to reduce.

She notes, however, that it’s her work with students at the University at Buffalo — in her roles as adjunct professor of pharmacy practice and the psychiatric pharmacy residency director in the School of Pharmacy and Pharmaceutical Sciences and associate professor of psychiatry in the Jacobs School of Medicine and Biomedical Sciences — that really motivates her to reverse discriminating opinions for future health care professionals.

“As an educator, I feel compelled to reduce misconceptions and change attitudes among upcoming pharmacists and other health care professionals in training, many of whom will work closely with people who are battling a range of mental illnesses,” says Demler, who also serves as the faculty adviser to the UB student chapter of the American Association of Psychiatric Pharmacists (AAPP) and as the only mental health first aid instructor in the pharmacy school. 

To gauge perceptions of individuals diagnosed with a severe mental illness — including schizophrenia, bipolar disorder, major depression and anxiety disorders ­— Demler has conducted studies of third-year pharmacy students enrolled in an ethics class. Most recently, she conducted one in 2024 with Claudia Lee, MD, who is a preceptor in the pharmacy program, and Kenny Nguyen, PharmD, a pharmacy resident. It focused specifically on perceptions of psychiatric inpatients’ voting rights.

Their findings were recently published in the journal Pharmacy Education. Demler is the lead author.

“We asked whether these patients should be encouraged to vote or allowed to vote if they lacked capacity. This is a term we use in psychiatry to determine whether or not you can make a decision,” Demler explains. “More students in this class felt that the patients should have the right to vote but not be allowed to vote, which was interesting.”

Even more interesting were the results of a follow-up survey students completed after Demler and the other presenters provided unbiased facts, including how people with a mental illness are much more likely to be the victim vs. the perpetrator of a crime, despite sensationalized cases that may involve someone struggling with their illness.

“Just 90 minutes later, after we had provided the data, we saw that student perceptions had changed favorably toward being less stigmatized,” Demler says. “Our bottom line was that you can change your perception by just providing actual data and actual statistics, not your opinion. We were excited by the outcomes.”

Specifically, 80% of the students supported allowing psychiatric inpatients to vote, compared to 63% before the lecture. When asked more broadly whether individuals with mental illness should have the right to vote, the affirmative responses increased from 88% to 96%.

“When I say ‘mental illness,’ people go right to the most severe versions, such as schizophrenia. However, the number of people with anxiety and depression is tremendously higher, and this has been especially true since COVID,” Demler says. “These are people who work next to you, who are undergoing treatment but are able to function. And, of course, there’s a spectrum. Some people are completely incapacitated by depression or anxiety and have to be hospitalized.”

The 2024 study stemmed from surveys Demler conducted with pharmacy students in 2021 and 2022, which were intended to gauge overall perceptions of the rights of people diagnosed with a mental illness.

“The questions focused on general hot topics — whether people with mental illness should have the right to refuse medications and vaccines, engage in sexual relationships, and own a gun post-hospitalization,” Demler explains. “Afterwards, we gave a lecture on 17 key messages related to mental illness and surveyed the students again.”

Students’ perceptions improved in every category except for one — whether individuals with severe mental illness have the right to vote. Most of the students said no.

“We hadn’t even talked about it,” Demler explains. “We thought this was very interesting, and we wanted to dig into it further.”

Changing perceptions of the capacities and rights of people with mental illness is important, Demler says, because negative interactions with health care providers and others can diminish their chances of effective treatment. And this comes at a time when more people across the United States are reporting fewer social connections and more isolation and loneliness, which has been linked to mental and physical harms, including suicide.

“Evidence shows that social connection is among the most powerful protective factors against suicide, regardless of whether an individual has a diagnosed mental health condition,” she says, adding, “Empowering individuals with mental illness to engage in civic duties, such as voting, can foster inclusion and self-worth.”

She says she would like to see this type of study replicated with students in other health profession courses.

“My hope is that I’ve imprinted on students that even the smallest interaction with somebody with a mental illness should be respectful,” she says. “We want our students to be more patient and understanding because that one interaction with someone could determine whether or not they continue in their efforts to be well. As health care professionals, we want to be part of the solution, not part of the problem.”