Tackling medication non-adherence in severe mental illness: where are we going wrong?

Although people with schizophrenia require medication to manage symptoms such as hearing voices, most do not take it as prescribed (they are non-adherent). We talked to psychiatrists, nurses and pharmacists about how they work with patients to help them be better at sticking with their medication. Although the professionals that we talked to recognized that treatment adherence was a major issue in their clinical work, they did not make best use of evidence-based interventions to address the problem. Often their practice was based on what they believed would work (e.g. patient education) even when the research shows that way of working to be ineffective. As far as we can determine, this is the first study to examine what interventions different mental health professionals report that they use in clinical practice to address patient's medication non-adherence. Non-adherence with medication is common in patients with schizophrenia. Addressing adherence to treatment may enhance clinical outcomes. Our aim was to explore mental health professionals experience and practise managing medication adherence in patients with schizophrenia. In this qualitative study, we interviewed mental health professionals from three key groups involved in promoting adherence: pharmacists, psychiatrists and nurses. Interviews were transcribed and analysed using a thematic approach. Thirty-five health professionals participated. From these interviews, we identified five main themes: my beliefs inform my practice; withholding information; adherence is important; who is responsible for promoting adherence?; and is it ok to pay people to take medication? Our overarching meta-theme was that practice with regard to promoting adherence was informed by beliefs and not by evidence. To the best of our knowledge, this is the first study to explore different mental health professionals' approaches to working with patients who do not want to take medication. The significance of participants' personal beliefs is an important observation. Our findings suggest that to support clinicians to more effectively help patients manage their medication, it may be first necessary to challenge pre-existing beliefs about adherence.