Strategies to Promote Medication Adherence in Mentally Ill Patients

This article discusses the strategies to promote medication adherence in mentally ill patients. It covers the Mental Health Act 2014, the right of the patient to refuse treatment, and a case study. The article emphasizes the importance of nurses in improving medication adherence and positive results using decision-making techniques that enable patients to participate in the decision-making process regarding their treatment.

Complex mental health

Table of Contents
Introduction................................................................................................................................2
Main context...............................................................................................................................2
Strategies to promote the administration of regular medication................................................2
Case study..................................................................................................................................3
Mental Health Act 1959.............................................................................................................4
The right of the patient to refuse treatment................................................................................4
Exceptions..................................................................................................................................5
Conclusion..................................................................................................................................6
References..................................................................................................................................7
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Introduction
Pharmacological treatment is necessary for alleviating psychotic symptoms. Antipsychotic
medications are effective in persons having schizophrenia. Non-adherence to medicines can
happen for numerous reasons like forgetfulness, economic constraints and lack of acceptance
for medication. Adherence to medication is a complex phenomenon involving environmental,
medication-related factors and patients related factors. Patient-related factors include newly
started treatment, young age of the patient, alcohol addiction, low social involvements and
economic constraints (Engdahl, 2010). Poor medication adherence is also exhibited by
minority ethnic groups. Non-adherence can also be caused by a lack of family support.
Adherence is influenced by medication and perception regarding illness. Medication
adherence is more among patients who are aware of their illness and wants to avoid
hospitalization. Favourable results and no intolerable side effects are the main cause of
medication adherence. The cardio-metabolic problem has prompted health staffs to focus on
treatment and medication adherence of the population. Partial lack of adherence or complete
lack of adherence has caused several negative results. The bio-psychosocial model is used by
Psychiatric nurses. This model includes client education and spiritual support to the client. To
improve treatment follow up decision-making strategies should be adopted regarding
medication and behavioural therapies.
Main context
Strategies to promote the administration of regular medication
The specific problems relating to adherence can be solved by various available support
services. Counselling is provided by therapeutic support service. The negative perceptions
and inaccurate beliefs regarding medication can be removed by cognitive-behavioural
therapy. Cognitive-behavioural therapy is often used in motivational interviewing.
Motivational interviewing enhances the confidence required to adhere to the medication
routine. Compliance theory includes cognitive-behavioural therapy, psycho-education and
motivational interviewing. Non-adherence to medication is associated with a high risk of
rehospitalisation (Delafon et al., 2013). Schizophrenic patient requires antipsychotic
medication and therapies to maintain symptoms under control. Psychiatric nurses can take
steps to improve medication adherence and positive results using decision-making techniques
that enable patients to participate in the decision making process regarding their treatment.
For reducing relapse risk continuous treatment with antipsychotic medication is required for
the schizophrenic patient. The etiology of schizophrenia may include environmental, genetic
and neural components. Antipsychotic medication affects neurotransmitter receptors. In the
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earlier medical model, the client has to comply with the medication recommendations and
have no role in decision making. After the president's new commission on mental health, the
decision-making concept has gained momentum (Jimu & Doyle, 2019).
The psychiatric nurses association collaborated with mental health service association and the
substance abuse to transform the recovery concept. Through the recovery process, the clients
improve their wellness and health. Self-directed life is accompanied by a sense of
responsibility and empowerment. Clients want to get more involved in mental health
treatment. The nurses may preach that lack of medical follow up can lead to hospitalization,
relapse, criminal arrest, and suicide. This leads to frequent disruption in relationships and
poor living quality (Latha, 2010). A review team will analyze the various factors that lead to
poor medication adherence like lack of access to health care facilities, cognitive deficits,
comorbid substance abuse, economic constraints and lack of social support. A weak
therapeutic alliance can also cause medication non-adherence. Therapeutic alliance is the
relationship between the client and the medication provider. The therapeutic alliance is of
great importance as it engages in bringing change in the client that is beneficial. Nurses play
a very important role in medication follow-up by identifying the hindrances and effective
strategies that can be followed. The nurse has an extensive contract with the clients and is the
first to detect non-adherence to medication (Molloy, Field, Beckett & Holmes, 2012). It is
important for nurses to understand the treatment goals and to give priority to personal
preferences and explain adverse events.
Case study
Sam a white male was psychotic, delusional and paranoid. He could hear different voices
which rather than helping him is troubling him. His apartment burned as he got distracted by
those voices. He is of view that he has no privacy as someone is spying on him continuously.
Sam works in a medical coding company but those voices are even interrupting him at his
workplace (Usher, Baker & Holmes, 2010). Sam was distressed because of weight gain
followed by medication. As Sam did not have a family to remind him to take regular medical
doses he switched to LAI antipsychotic. Sam was brought into the secure treatment unit and
he was feeling depressed. He refused to accept the olanzapine which was needed to manage
the illness. The nurses find it very difficult to provide the olanzapine and they felt that forcing
him would affect the caring relationship. The nurses also wanted to use therapies in order to
assist Sam to overcome from mental health issue. The nurses were very much uncomfortable
while providing medication and dealing with Sam. It was a challenge for the nurses to
educate Sam and convincing him for the treatment. However, the nurses were able to
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communicate with Sam about the benefits of the treatment and also speak with his family
members in order to convince him. The nurses were able to convince Sam for carrying their
medication process (Vuckovich, 2009). The most appropriate medication and therapies were
being applied by the nurses to assist Sam.
Mental Health Act 2014
The Mental Health Act 2014 of Victoria focuses on people suffering from mental illness. The
decisions are made on the basis of the need and care of the patients. The Mental Health Act
motivates psychiatrists, nurses and other health practitioners to develop effective and strong
relationships with the individuals who use mental health services and provides them support
and information in order to make informed choices about the care. The act promotes
oversight mechanism and forms robust safeguards for protecting the dignity, autonomy and
rights of the people with mental illness (Health, 2014). The act encourages support decision
making and supports strong communication between consumers, healthcare professionals,
carers and family members. The mentally ill persons are encouraged to participate in the
treatment process and their preferences and views are considered and respected. The core
principles and objectives of the Mental Health Act are as follows:
 Treatment and assessment are being provided in the least restrictive and intrusive
way.
 People are supported to participate and make in decisions about their treatment,
assessment and recovery.
 The rights, autonomy and dignity of the individuals are promoted and protected all
times.
 Priorities are given to support options and holistic care that are responsive to the
needs of the individuals.
 The safety and wellbeing of young people and children are prioritised and protected.
 Carers are supported and recognized in decisions about care and treatment.
The right of the patient to refuse treatment
Patients have both the right to treatment and the right to refuse treatment. Any person who
voluntarily enters the hospital and pose no risk to himself or others’ can express his right to
refuse treatment and leave the hospital premises. The right to refuse treatment is also
applicable to psychiatric treatment. The right to treatment has been formulated by the court
keeping in mind facts from previous cases where people in psychiatric hospitals were left
without treatment for many years (Garman, Johnson & Royer, 2011). After the incorporation
of the right to treatment law, the patients in public psychiatric hospital have to right to receive
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the same standard of care as expected from an accredited psychiatric hospital. The right to
refuse treatment is also a legal requirement for psychiatric treatment. No person can be
involuntarily admitted to a hospital for accessing treatment. No health staff can treat a patient
against their will unless there is a court order in this regard. The right to refuse treatment is
based on the right to privacy, equal protection and due process of law. Patients have the right
to take a decision regarding their bodies. The right to refuse treatment can result in patients
being locked up in hospitals rooms and insurance companies denying the claim of the patients
as there was no treatment. The state psychiatric hospitals cannot refuse treatment to anyone
who cannot afford the payment.
Exceptions
There are certain exceptions to the right to refuse treatment. In an emergency situation, the
doctor may administer drug involuntarily to control the emergency situation. When there is
an imminent danger to the patients or others the doctor may provide emergency medication to
tackle the situation. After the emergency period, the doctor has to take consent of the patient
to continue treatment. Even if there is a possibility of another emergency situation the doctors
must take patient’s consent before treatment (Levin, Hennessy & Petrila, 2010). The hospital
may take court order in order to commence an involuntary treatment of the patient. The judge
after taking into consideration relevant facts and issues will determine whether or not such
treatment is necessary for the benefit of the patient.
Patient under medication is exposed to both harms and benefits. Benefits received are the
management of the disease and progression in the disease. Harm can be caused by medication
error like the wrong dose and the wrong time. Nurses face the challenges of providing the
right medication to the patient at the right time. Medication errors in intensive care units and
emergencies can cause an adverse drug event or death. Wrong dose and wrong route of
administration is the most common type of medication error. Medication error is quite hard to
detect and as a result, effective strategies to prevent medication error has not evolved. To
improve adherence medicines are sometimes administered in a hidden way in food. Covert
medication touches patient autonomy and competence (Morkunas, Porritt & Stephenson,
2015). Covert medication breaches ethical practice and trust in the patients. Covert
administration of the drug is used as a last resort in the best interest of the patient. The nurses
can remind the patient regarding any follow-up. Non-adherent patients should be given
information regarding how medicines cure their disease. The nurses can change the way in
which the medicine is administered to them if felt uncomfortable by the patient. Non-
adherence tendency is mostly seen in young adults who drop out of their medication routine.
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They should be given proper information like non-adherence can increase the gravity of the
disease and will subsequently lead to rehospitalisation. Non-adherence to medicines can be
for numerous ways and when non-adherence is for economic constraints the nurse can
suggest the patient take treatment in state psychiatric hospitals as state psychiatric hospitals
do not refuse treatment to anyone who cannot afford the expenses of treatment (Taylor,
2015). The nurses should personally contact the patients to inform them regarding their
follow updates in the clinics. In case no other way is working out the nurse can take resort to
Covert medication which is the last resort. In convert medication, medicine is administered to
patients without his knowledge. When a patient is ill to such extent that he cannot distinguish
things the health care centre can take permission from the court for conducting treatment to
such patients. Without such permission, no involuntary treatment can be carried out (Grice &
Meehan, 2016).
Conclusion
There are many strategies that are evolving to improve the process of treatment in mentally ill
patients. This improved strategy focuses on practical methods to cope up with the emerging
problem. To ensure implementation of this strategy the health workers must involve and
engage themselves with the process. The nurses should be flexible regarding their shift timing
and delivery of the health care services. The nurses should be dedicated to improving the
health and well being of the mentally ill patients. Concerted efforts have to be made by the
nurses to address fear, misconceptions, constraints, and stigma that will in turn help in
transforming and improving the mental health system of the population.
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