It can be challenging if a person wants to stop taking medications that are helping them manage symptoms. Understanding why they want to stop is essential. Is it due to side effects or to a lack of awareness of illness? These are two very different situations. There are times when a clinician can support a person’s desire to lower or even stop their medications. This conversation ideally takes place in the course of a strong alliance between the clinician, patient and family, where risks and benefits are all fully discussed. People with SMI, but who are competent, can make choices with which a prescriber may not agree. Slow tapers of medication with careful monitoring for the return of symptoms can be a way to learn together about the impact of dose reduction. If medications are stopped, it is important to continue to see the clinician regularly so that they can observe and discuss the patient’s experience and look for the emergence of symptoms.