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Helping Clients Understand the Role of Medication

Medications can help in managing symptoms of mental illness, but many clients remain reluctant. A few approaches can open a dialog on prescription medications.

Dartmouth PRC-HazeldenClients may be reluctant to take prescription medications for a number of reasons-even when they might benefit greatly from them. Clinicians play an important role in education such clients about various medications and engaging clients in choosing the most appropriate pharmaceutical approach.

Addressing Stigma

Stigma is still attached to mental illness and can lead to avoidance of treatment. Clients find it helpful when clinicians simply acknowledge the presence of societal stigma and address their fears about being judged negatively by others. It may help for clinicians to point out famous people who have acknowledged a mental illness. Actress Brooke Shields and TV news commentator Mike Wallace, for example, have written about their experiences with depression and medications.

Some clients see their mental illness as a weakness or a personality defect. It may help if the clinician explains that mental illnesses are at least partially hereditary. Some clients inherit a low biologic vulnerability for developing a particular mental illness. Others inherit a higher likelihood of developing that mental illness. Stresses in life-including losses, physical health disorders, or substance abuse-can increase the chance that a mental illness will develop in the presence of heredity factors.

Dealing with Lack of Awareness

Many clients with schizophrenia and bipolar disorder are not aware that their symptoms are unusual or problematic. This lack of awareness is probably biological and does not need to be addressed by clinicians. Rather than focusing on the mental illness diagnosis or symptoms, clinicians should focus on clients' personal goals and encourage them to use medication as a way to make progress toward those goals. Xavier Amador's excellent book I Am Not Sick, I Don't Need Help describes strategies that are helpful when working with clients who lack awareness about their mental health disorders.

Using Shared Decision Making

Since there are multiple medication options for every mental illness, a shared decision-making approach between clinician and client helps clients make the best choices regarding treatment. Clients are the experts on their mental illness and substance use experience, recovery goals, treatment preferences, and responses to treatment. Clinicians are the experts on treatment options, likely success of these treatments, and the risks and benefits of each treatment. Clinicians and clients share information with each other and discuss all the relevant issues around symptoms, goals, and treatment options. Clients then choose, in partnership with the clinician, the treatment option they feel is best for them. Clients should be given information about their medications. Handouts with information and instructions are extremely helpful. The Food and Drug Administration publishes free patient information sheets that can be downloaded. 

Collaborating in the Treatment Plan

Once clients decide to try a medication, clinicians can help them develop a plan to use medications wisely. Clinicians need to tell clients that medications should be taken as prescribed, even if they are feeling better. Clients need to know how long it will take for the medication to take effect. This is usually days to weeks for initial effects and a month or two for full effects. Clinicians should discuss common medication side effects, as well as possible serious side effects, and they should give clients information about how to manage side effects if they occur.

Clients will be more willing to take medications when they have good information about what to expect. They will also be more willing if they have reassurances that their clinician will help them address whatever medication problems arise. Clinicians should also provide clients with information about whom to call if they have questions or concerns about their medications. The use of medication should be linked to each person's personal recovery goal (ex., getting better sleep, reuniting with a child, etc.)

Excerpted from Integrated Dual Disorders Treatment: Best Practices, Skills, and Resources for Successful Client Care by faculty from the Dartmouth Psychiatric Research Center. Center City, MN: Hazelden, 2010.

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