It is an unfortunate truth that many mental illness patients won’t take their medications at one time or another. This is known as treatment noncompliance or treatment nonadherence, if you want to be a bit more politically correct.
And also unfortunate is the fact that when a person with a mental illness refuses to take their medication they almost inexorably get sicker. People with bipolar disorder who won’t take their medication, for example, often become manic and then wind up hurting themselves or someone else and end up in the hospital. And watching this happen, as a loved one, is extremely painful.
So is there anything you can do when a person refuses to take their medication? Is there anything you can do about treatment noncompliance?
Why Does a Person Refuse to Take Their Medication?
I think the most important question to ask is why is the person refusing to take their medication. The answer to that really dictates what to do next.
There are really three reasons mental illness patients are noncompliant.
- The medication isn’t working and their illness convinces them to go off their medication.
- Their medication is working but the side effects are intolerable.
- Their medication is working, they’re experiencing wellness and so they think they no longer need their medication.
Refusing to Take Medication Because the Medication Isn’t Working
Refusing to take medication that doesn’t work is understandable. We’ve all been there and we’ve all seen the futility of taking some medications. But, the thing is, you have to get through the medication that doesn’t work to find the medication that does and going off of medication is not the way to do this. If the medication isn’t working, it’s time to work with a psychiatrist to find better medication that does work for the patient.
In this case a loved one might want to approach the case logically and say that without treatment, the mentally ill patient can’t get better. Stopping the treatment was understandable, but now it’s time to assert some control over treatment and find something that works.
Refusing Medication Because of Intolerable Side Effects
This is understandable as well. Many of us have been in the situation where side effects destroyed parts of our lives. But again, just stopping medication is not the way to handle this problem. Working with the doctor to find better treatment is the answer.
In this case patients often feel like they have told their doctor about the side effects but the doctor hasn’t listened. This might be true. But that’s why it’s time to, again, assert more control over treatment choices and state to the doctor clearly that these side effects are intolerable and another treatment must be found. If laid out in this straightforward manner, most doctors will get the message and help. Just “complaining” about side effects doesn’t have this same effect.
Families can help by attending psychiatric appointments to help get treatment back on track in a way with which the patient agrees. And it’s important to remind the patient that better treatments are available and they don’t have to live with horrendous side effects. Treatment is in their control.
Refusing Medication Because They Believe They Don’t Need It
Unfortunately, this can be the hardest situation. Once a person is well, they see the medication as a hindrance, forgetting that it is the medication that made them well. This is a trick of the mind. No one wants to be on medication and this is a trick the mind plays to provide an excuse for refusing medication.
A loved one can approach this situation with logic such as, “remember before the medication, you did such-and-such, whereas on the medication, you’re able to such-and-such . . .” (And I should mention that just because a medication works once, it doesn’t mean that restarting it will make it work again in the same way. This is one of the major dangers of going off of working medication.)
However, the truth is that the patient may simply have to fall before they realize that it was the medication that was holding them up. For a loved one this is painful to watch but try to remember to be there if something like this happens and help out with returning to treatment.
Helping a Person Who Refuses Medication
No matter what camp the person falls into, it’s very hard, but try to look at the situation from their perspective – they likely have a real reason why they are treatment noncompliant. Try to speak to that reason with compassion and concrete reasons why they should work with their doctor to rectify that problem rather than try to handle it on their own.[push]Remember, the best medication is the medication a patient will take.[/push]
And as I’ve said above, remind them that real honesty with their doctor is the most important thing and that they are in control of their own treatment. And, if you can, try to support their wishes and act as their back-stop in psychiatric appointments. People dealing with psychiatrists often feel more comfortable being honest with this back-up which means they are more likely to get treatment that works for them.
There is actually much more to say about handling this problem, but, alas, I’ve gone long already. Hopefully a part two will make it’s way here at some point.