Psych Med Non-Compliance: Why Won't He Just Take The Pills?

Ever since my son's diagnosis of schizophrenia, we have had to work around his strong desire to live without his mental health medications. In the past, he has refused them, cheeked them, thrown them up after swallowing them. They've been hidden in his pockets, his closet, in the bottom of the garbage. Things are better now, but mostly because we are on to his tricks. I'd like to think he is cooperating because of some insight--but the most probable reason is that he simply can't get away with not taking his psych meds anymore.

Psych Meds and Non-Compliance With Drug Treatment

Every medication trial, in the early years after his diagnosis, was compromised because we could never be sure if he was taking the full prescribed dose. Every one of his hospital stays has been extended because of medication non-compliance. Each of the three relapses he has suffered after stabilization has been because he somehow stopped taking his meds.

Why? How many times I asked myself that question. To anyone else, it would make sense, I told myself. But, finally, I learned some truths: Ben does not agree he has an illness - not yet. The medical reason is a neurological syndrome called anosognosia, the inability to recognize a mental illness in oneself. It occurs in 50% of those with schizophrenia, and about 40% of those with bipolar disorder. Although this awareness sometimes improves when stabilized on medications, that has not yet happened for Ben.

So my job, I have learned, is not to convince Ben he has schizophrenia. In all my conversations with people who do have this awareness and manage their own medication regime themselves, no one has ever said to me "My mother finally convinced me I have schizophrenia." Not one person.

So my job right now is just to require that Ben take his psych meds whenever he stays with us, and keep any other caregivers and case managers aware of the need to supervise carefully - and with empathy. Ben is not just being stubborn - although he certainly can be! It is not our place to judge him - just to make sure he does what he needs to do until the time he has that aha moment - if he ever does. Whatever. In the meantime, wishing doesn't help us - but staying in the moment, and doing what must be done, does.

What To Do About Psych Med Non-Compliance

But - it helps to understand why many people may not want to comply with their psychiatric medication regime. So:

Some reasons for medication non-compliance:

• Lack of insight into illness (biological – the brain is impaired)
• They believe they don’t need it anymore (“I feel fine now”)
• They think they never needed it
• They don’t like side effects (weight gain, sexual performance, sedated feeling)
• “If I don’t take meds, then I’m not sick” (wish not to be ill)
• Power play between caregiver and ill person
• Complicated regimen – having to be home to take medication
• Forgetfulness
• Fear of becoming medication-dependent
• Feeling different from everyone else

What you usually can't do: Convince your relative, by reasoning and arguing, he or she is "sick" and needs to take the medications.

What you can do:

• Watch for signs of relapse, return of symptoms
• Call doctor, request evaluation
• Call caregivers, if applicable, and alert them
• Be aware of any increased stress in relative’s life, and reduce it if possible
• Know your limits and what you’ll do if they are not met
• Increase supervision of medications if you can

For all of this to happen, by the way, open communication and partnership, whenever possible between consumers, caregivers, and healthcare providers is essential. Insist on it, in whatever manner you can.