Many clients who have been identified as having a comorbid mental health disorder will have been prescribed medication for that disorder (such as antidepressants, mood stabilisers, anti-anxiety agents, and antipsychotics). Medications can be extremely helpful in managing mental health symptoms; however, some people experience unpleasant and distressing side effects from these medications which may lead to reduced compliance. Indeed, some people with a mental health disorder choose to live with some symptoms of the disorder rather than take medication [426].
It is important for clients to be aware that in most instances there is a choice of medication but it may take time to establish which medication is best suited to his/her needs. Finding the best fit is particularly important for individuals with severe mental disorders such as psychotic, bipolar, and severe depressive disorders, as psychosocial interventions alone can prove ineffective.
When medications have been prescribed, it is important to assist the client to adhere to medication scheduling. In other illnesses such as diabetes and hypertension, medication compliance is recognised as an important issue in regaining good health and it is addressed proactively by the use of simple techniques to remind the client when he/she needs to take medication.
MI, contingency management and cognitive behavioural techniques have been shown to be particularly useful in improving medication compliance [427]. The SIMPLE model [428] is a useful tool for remembering different evidence-based interventions that can enhance medication adherence:
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Simplifying regimen characteristics. Adjust timing, frequency, and dosage.
Match regime to client’s daily activities (e.g., meal times). Use adherence aids
(e.g., pill boxes, alarms).
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Imparting knowledge. Clearly discuss the medication with the client using simple everyday language. Don’t overwhelm the client with information or instructions. Supplement verbal information with written materials or pamphlets.
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Modifying patient beliefs. Assess the client’s beliefs, intentions, and perceived ability to adhere to the medication regime. Encourage this behaviour change by ensuring that the client perceives their condition to be serious, believes in the positive effects of the treatment, perceives themselves to have the skills required to stick to the medication regime, and has channels to express fears or concerns.
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Patient and family communication. Include the client in decisions about treatment. Send reminders via mail, e-mail, or telephone. Actively listen to the client and avoid interrupting them. Involve family or social networks where appropriate.
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Leaving the bias. Studies have found small or no relationships between medication adherence and race, sex, education, intelligence, marital status, occupation, income, and ethnic or cultural background.
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Evaluating adherence. Ask the patient simply and directly, without judgement, about their medication adherence. Pill counting or measuring serum or urine drug levels can also be used.
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Adapted from Atreja et al. [428].