Med noncompliance

Medication noncompliance is a large issue that affects patients and leads to relapse and re-admittance into a mental health facility. Why is medication non- adherence or noncompliance so common?

To begin medication noncompliance is when a patient stops taking their medication. The patient may not take the medication at all, fake taking it, or take a lower dose than normal. All are forms of treatment noncompliance and is very common in the mental health community. What are the reasons for such actions?

The first reason is that patients believe that they do not need the medication. With lots of mental illnesses such as bipolar and schizophrenia, the patients will take the  medication for a period of time and then suddenly stop taking them. They will cite that now that they are stable they do not need the medications. With the stabilization of symptoms, the patient does not "see"  why they need to take the medication. They falsely believe that their mental health is ok and that the medications treated them like you would a temporary illness..

Another common belief is that the patient is not sick in the first place. They lack any insight into their mental illness so they will tell their providers that they do not have any mental disorder and thus do not need any medications. Even if they are manic or severely delusional, the mania or delusions are telling them that they are "well" and do not need treatment even though everyone else can see otherwise. 

The patient may also take the medication and spit it out after "taking it". This kind of medication non compliance is common in locked facilities where they are forced to take medication but still resist treatment. In this case the providers would be best off treating the patient with an injectable form of the medication so that the patient cannot spit it out or fake taking a pill. 

Medication noncompliance and relapse rank high in reason for hospital admissions. The majority of patients are those who are either experiencing their first episode or those who have relapsed due to noncompliance. And it is only a matter of time before the patient comes to the attention of the court for repeat hospitalizations. The treating psychiatrist will review the patient's history and with a long rap list of hospitalizations and noncompliance, they may consider filing for a temporary conservatorship.

All of these forms of noncompliance can be taken into consideration when the conservatee faces a judge who must determine if they are gravely disabled. Even though alone noncompliance is not a criterion for finding someone gravely disabled, many judges will weigh that in conjunction with multiple hospitalizations, diagnosis, and number of impatient visits. The court may find that without the services of a conservator, the patient will discontinue their medications and end up in the ER again.

For higher functioning patients, as a patient you may be best off agreeing to medication before court intervention is needed. Even if you disagree with the medication, you should strive to discuss with your doctor what options are available. Court intervention is lengthy and you do not want the choice to choose taken away. 

That is all for today.

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