What are some reasons someone with serious mental illness wouldn’t take their medications?

Medication adherence refers to the extent that someone takes medication as recommended by their provider. Medication non-adherence looks differently from person to person and can include failing to initially fill or refill a prescription, discontinuing a medication early, taking more or less of a medication than prescribed, or taking a dose at the wrong time. Individual factors associated with medication non-adherence include low education level, young age, cognitive impairments, paranoia, substance use, minority ethnicity, poor insight, low socioeconomic status, poor therapeutic alliance, and other barriers to treatment such as prior experience with treatment. The potential consequences of medication non-adherence among someone with serious mental illness include re-hospitalization, relapse of symptoms, reduced effectiveness of treatment, increased substance use, poor quality of life, and increased risk for suicide.

There are both intentional and unintentional reasons that people do not take their medications as prescribed. Intentional reasons include active decision making such as weighing pros and cons, possible concern for side effects, and stigma associated with needing or taking certain medications. Recommendations include open communication with providers for information, education, addressing concerns and helping to make informed decisions. Unintentional reasons for medication non-adherence include not being actively involved in treatment, forgetfulness or trouble taking medications at appropriate times, and not knowing how to use the medications. Recommendations include simplifying the medication regimen, establishing a system of reminders, and general support.

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