Mental health has been progressively recognized as a major health issue, to such an extent that currently the World Health Organization no longer talks about the four main non-communicable diseases (NCDs) but the five “biggies”. Mental health in general, and depression in particular, has a major impact on disability. Severe mental health conditions may also lead to suicide, a growing cause for concern, particularly among teenagers and young adults [1]. This led the European Society of Clinical Pharmacy (ESCP) to select this theme for their annual symposium in 2021 [2]. The unexpected COVID-19 pandemic led to interruption of many planned activities, aside with increasing demands for pharmacists, who had the duty to sustain essential services, aside with taking on new tasks [3]. Response measures imposed globally, which at times included lockdown measures alongside physical distancing, had major impacts on the mental health of all society, including pharmacists, making this topic gain even more prominence. More recently, in 2022, and continuing the work initiated in 2019, ESCP established a new special interest group (SIG) in mental health, to further contribute to the development of mental health clinical pharmacy. In this special issue, Stuhec and colleagues present a commentary paper highlighting the need for such a SIG to contribute to improved medication practices and safer medication use [4]. But the topic is, of course, not new and the International Journal of Clinical Pharmacy, as a leading journal in clinical pharmacy, has an established reputation for publishing relevant manuscripts focusing on mental health in general, including on the concept of “mental health pharmacists” [5].

Mental health covers a wide range of conditions, including depression, anxiety, psychosis, opioid dependence, dementia, to name a few. This means that the specific papers covered in this special issue are also diverse, and our authors have contributed opinion pieces, review articles and research-based papers that cover many of these topics. However, the focus tends to be on medication use and on specific roles and activities developed within the scope of clinical pharmacy. Medicines optimization, which includes medication safety and effectiveness, is a core concern of any clinical pharmacist and therefore this is a theme in many of the manuscripts included in this special issue. It has been previously shown that medication misuse may lead to urgent care, which impacts clinical outcomes at the patient level, but also economical outcomes at the healthcare system level [6]. In the papers by Raza et al. and by Howe et al., focus is placed on the use of antipsychotic medication [7, 8]. Deprescribing is also extremely relevant in mental health, as highlighted in previous publications of this journal [9], and as described in this special issue by Rodrigues Melo et al. focusing on benzodiazepines [10], and medication review and prescribing, as illustrated by Kallis and Allison centred on z-drugs [11]. Ensuring that the duration of treatment is appropriate for the condition being managed is essential in achieving success. McGoldrick and colleagues focus the tapering process in the case of antidepressants [12].

Services that are still scarcely disseminated but with promising results include pharmacogenetic testing. In this issue, Scherf-Clavel and colleagues investigate how the CYP2D6 functional enzyme status affects serum concentrations of common psychotropic drugs and demonstrate the need to include pharmacists in interpretation of results, especially prior to treatment initiation, to ensure adequate dosing [13]. In this special issue we also cover emerging roles for pharmacists, which are not necessarily linked with the medication use process, such as suicide prevention [14]. Pharmacists are in contact with the general public on a daily basis and are therefore very well positioned to become part of the solution, as long as integrated in adequate referral pathways [15]. In this issue we focus on current clinical pharmacy practice, but the future is dictated by trends in education and training. Previous publications in this journal had adressed this issue by exploring training needs [16]. In the current issue, we have also included interesting examples of how pharmacy curricula are being shaped, both at undergraduate and postgraduate levels, to better prepare pharmacists competent in mental health clinical pharmacy [17, 18].

In summary, this special issue provides an overview of emerging trends in clinical pharmacy in mental health care, showcases the value of new services being developed in this area, exploring key roles for pharmacists, and underlines the importance of education and training in mental health to achieve a competent workforce.