How Family and Friends Can Help Someone Who Resists Taking Medications
By Ronald J. Diamond, M.D.
Reprinted from Relapse,
a Yale University magazine
The concept of treatment-resistance (i.e. won’t take mediations) assumes that a psychiatrist’s decision about what is good for a patient is correct and that there is something wrong with a patient who resists the help offered. It is equally likely, however, that something is wrong with the treatment being resisted: Treatment resistance may mean that we want to sell something that our patient does not want to buy.
Studies have shown that patients more readily comply with treatment and have an improved outcome when they form a collaborative therapeutic alliance with their family and therapists. To foster this alliance, both need to show more interest in the person’s aspirations and discuss how taking neuroleptic medications may help them to meet their own goals. A good place to start is by seriously listening to what they say that they want for their lives rather than starting by telling them what hey should do.
It is important to take seriously what a specific client wants, no matter how unreasonable it may initially seem. For example, if a patient wants to be an astronaut, I can tell him that’s ridiculous or we can discuss steps he might take toward attaining this goal. The first strategy closes off conversation, while the second opens doors to further communication.
Although becoming an astronaut may be an unrealistic goal for someone with mental illness, discussing it can help promote intermediate steps like taking meds.
Forming a collaboration is not easy. It can take time. I had one patient, for example, who refused to talk and refused medication. When I asked her what she wanted, she said, “to eat.” So every few weeks we went out to lunch. She accused me of trying to bribe her to talk. I acknowledged that we both got something out of the lunches…she got to eat and I got her to talk. Over the next year she agreed to take her meds and has been doing so ever since. We collaborated. Lunch every few weeks was less costly and time-consuming than traditional approaches.
Patients will be more likely to take meds if they believe it will improve their quality of life. Side effects may deter people from taking meds if they see no hope for ever living independently, even with meds.
If a patient believes that meds will allow one to hold a job or socialize with friends, they may find the side effects worth tolerating.
Ten tips to reach people resisting medicine
- Put treatment in the context of the patients’ lives.Be concrete about what they will gain by taking meds.
- Start with the patient’s own agenda.Take seriously what they say they want for their lives.
- Be concerned about whether patients follow through with agreed-on treatment plans.Ask specific questions designed to open up dialogue rather than put them on the defensive.
- Involve patients as much as possible in decisions about their treatment.Provide information about treatment options and resources that patients can use to solve problems and enhance their lives.
- Make sure patients, their families and involved agencies are kept informed about the treatment options and plans.Be sensitive to the agendas and prejudices of these people and try to work with them.
- Try to involve friends, families, landlords, clergy and others as confidentiality allows and as it fits into the patient’s own goals and agendas.People in support systems exert considerable influence in patient’s decisions.
- Be willing to be tenacious when necessary.Be flexible about how you can engage patients.If they decline med, focus on “safe” topics first.
- If warranted, connect medication compliance with continued community involvement.If necessary, try linking medication use with activities with patient needs such as obtaining spending money.
- Accept the fact that some patients refuse treatment despite all efforts.Offer what you can—be it bowling or lunch.Patients may be more willing to comply with treatment once a relationship is established.
- Plan for anticipated crises.Use them to build trust.Following through on promises will strengthen the therapeutic alliance.