Mental Illness/Medication Noncompliance - Research Paper Example

Mental Illness/Medication Noncompliance When Hurricane Katrina hit the coasts of New Orleans, drowning 80% of it in flood water, not only the city was damaged but also the entire lives of the people dwelling there were wrecked. The loss of infrastructure, buildings and health care facilities increased the number of mental disorders amongst the survivors. The low-quality and deficiency of food, lack of transportation, running short of psychiatrists, medications and proper hospitals with qualified doctors as well as the trauma from the hurricane were some of many reasons that resulted in the occurrence of mental illness in the people there. This paper concentrates on the reason how the people became mentally ill, how some chronological disorders resurfaced in some patients and if they were given any treatment, what were the reasons behind their noncompliance to it. Why didn’t they adhere to their prescribed medication? When a patient does not adhere and comply with the prescribed medication, not only it affects him but it also has a huge negative impact on his family. And support from one’s family plays a major role in pulling psychiatric patients out of their illnesses, or at the very least, lessen it. Jin et al. (2008) defined non-compliance as the mismedication that occurs when a patient, willingly or unwillingly, neglects to follow the prescription given by their doctor. Non-compliance may include situations (Jin et al., 2008) when the patients: Do not fill a received prescription Consume a wrong dose Do not follow the prescribed timings of the doses Change the amount of the doses Stop the treatment prematurely Do not make regular clinic visits Take a medication which was prescribed for someone else and many others. Such situations of non-compliance by the patient may lead to severity in the illness and the patient might need to start the treatment all over again, might as well with higher doses of what he was previously used to. The patient might be required to admit in a hospital or, even worse, the severity in the illness can lead to the person’s death too. This is why coping with such situations and taking imperative steps to avoid it is of high significance. The people who suffer from psychiatric disorders tend to forget things more often as compared to the people who do not suffer from such illnesses. If the non-compliance occurs because of patient’s forgetfulness, it becomes easy to handle such a situation. And if not, then it means the patient is willingly not complying with the situation and forcing a patient to take their medicines can have an adverse affect on them. There can be many reasons for a patient’s non-compliance to the medication prescribed. After New Orleans was hit by Katrina, the hospitals, clinics and health systems were extremely damaged. If a building was present, it had no doctors or psychiatrists in it. According to Eisler (2007), around 300 beds for psychotic patients were lost in the disaster, reason being closed hospitals and departments. The deaths that occurred after the disaster was gone were mainly due to stress, strokes or suicides; suicide rate increased 300% after a quarter of a year passed. Another survey showed that 26% of the respondents had at the very least one family member who was suffering from a mental disorder and needed psychotherapy, and among those only less than 2% were getting any help with it (Eisler, 2007). One of the main causes to a patient’s noncompliance is the absence of a support system. People suffering from depression, post-traumatic stress disorders and disquiet were ready to take counseling. But since, only 22 out of 196 clinical psychiatrists returned after Katrina wrecked havoc, those patients had to wait in line to get to their turn (Eisler, 2007). Due to this, the chronic illnesses such as schizophrenia and bipolar disorders which the past patients suffered from were resurfacing because they couldn’t get their treatment. Impatience mounted amongst the patients. Some patients dropped their medication and were exposed to the risk of a complete takeover of the disorder, which resulted in them landing in a cell in jails rather than in a bed in hospitals (Ferris, 2010). Another reason for the patient’s noncompliance may also include the worry of the side-effects or discomfort those medications could cause. Any negative perception about the medication and its after-effects such as physical pain, laziness or even the complexity of the treatment can lead to reducing the chances of compliance and a lack of trust of the patient over the provider (Jin et al., 2009). Since, Katrina’s after-effects also included medical illnesses, the perception amongst the patients regarding the side-effects mounted in negativity. Also, as there were such few numbers of psychiatrists available in the affected area, consultation regarding the medication would’ve taken more time due to the rise in mentally ill patients. This resulted in the patient reducing or completely neglecting their medications. Social and economical factors such as commitment of time, cost of the therapy and whether it fits the income of the patient as well as social support to the patient are imperative factors. After the economical situation of the affected areas of New Orleans hit a low due to the disaster, the money situation of its people deteriorated too. In the start, the basic necessities weren’t met such as food, clothing and a shelter. Even now the situation is pretty thin on the ground (Eisler, 2007; Farris, 2010). Similarly, if the patient is suffering from chronic illness, the medication would take a front-seat amongst the factors that could save his life. Since, the Katrina-hit patients have minimum ways of earning money, especially when the infrastructure and buildings are closed down, it is most likely that the people there would be absent from checkups and won’t be compliant to the prescriptions. Therefore, it is better for health personnel to be aware of a person’s economic background before prescribing them medicine. Also, support from one’s relatives, spouse and family plays a vital role in motivating a patient and to deal with the disorder in a positive and compliant attitude (Polgar, 2010). After the disaster, however, high rate of domestic violence was visible (Eisler, 2007). That causes distress and tension amongst the family members and the support a mentally ill patient requires cannot be properly established and given to him. When a patient does not get support from his family, the chances of him leaving his medication in the middle of the treatment are high. There is no way to treat such a problem then the family members to be more tolerable towards the patient and understand his situation as well. The education of a patient affects his knowledge of the disease as well as the medication. But the relation of education with the patient’s compliance varies. Sometimes it happens that the patient, when armed with proper information about the diseases and the medication, might not trust the provider. While in other cases, with education he would know that taking his pills seriously and regularly is critical for his health. In the same way, lower educated people have proved to put a lot more faith in their health personnel and therefore, show higher compliance (Jin et al., 2009). So, all in all, education is not a strong factor by which we can judge a person’s non-compliance. In another case, people with enough literacy level so that they can read, write and understand their medication instructions, are more compliant as compared to those who have difficulty understanding those instructions (Jin et al., 2009). It is stated in an article by Farris (2010) that starting the construction of buildings and homes which were safe and protected would have a direct effect on recovering from mental illnesses. After the disaster, thousands of people went homeless as their homes were destroyed in the hurricane. And there wasn’t enough space in hospitals and other sanctuaries where they could’ve survived. But surviving in such areas seems fine for a couple of months, not for 4-5 years. This was another reason for the patients to get frustrated and commit crimes. They refused to believe that they were suffering from any illness and hence, avoided the treatment and medication that could’ve made them a better person. Instead, such patients believed in self-medicating themselves with the use of alcohol and drugs (Farris, 2010). According to Foster (2009), mental disorders increase the chances of drug abuse and the most probable conditions of a mentally ill patient abusing drugs and going for alcoholism might include depression, schizophrenia, bipolar disorder and anxiety. Also, such patients show a risk-taking behavior. The statistics show that 50% of people with addictive disorders would also be suffering from psychotic disorders. And amongst those patients suffering from psychotic disorders, 20% have and addiction problem. And this statistics rates higher with the conditions mentioned above (Foster, 2009). A report by the police crisis unit stated in Farris’s (2010) article admits that after the hurricane disaster, there has been a rise in drug usage especially amongst the teenagers. Also, 36% of calls received on the 911 helpline have cases of people seriously drugged. A lot of solutions have been proposed by the researchers, for different types of compliances, especially the ones we have discussed above, as well as solutions on a general level. If the patient stays worried about the after-effects and side-effects of the medications, the provider should take him into confidence and shows the patient that he can manage those side-effects well, which will result in increased compliance (Jin et al, 2009). Many patients who are afraid of side-effects think that to stop those effects from happening, the only step they should follow is to stop their medication. Therefore, the health personnel should deliver it to the patients that not all side-effects occur and most of them can be strategically managed by decreasing doses or changing medicines. The provider would need to get the patient to communicate the side-effects that he has faced and their intensity as well. The provider can motivate their patients into not dropping their treatment by offering practical solutions through adequate communication. A study by Ruetsch (2010) talks about a patient support program: HereToHelp. In this program Certified Addiction Counselors (CAC), who are trained in addiction education, contact with the patients through telephonic conversations. A total of 8 calls are made in the first month of the treatment which reduces as the patient reaches the level of maintenance. This is an active therapy program where the care coaches give encouragement to the patients, informs them about their medication till the patient develops a habit of it, engage the patient in counseling and let them know of further services that their program can provide them. On a general level, there are tested and tried steps on the part of the physician, the patient and the patient’s family, which, when followed, show positive results in the medicine-intake behavior of the patient. Communication plays a major role in developing a healthy relationship between the provider and the patient, and a healthy relationship leads to greater compliance on the patient’s part. Empathy and concern from the provider, time management, focused written materials given to the patient and an atmosphere of encouragement can lead to the patient being more open about their feelings and situations as well as difficulties that they are facing, whether it is with the medication or anything else (Jin et al., 2009). Since the affected people of Katrina are mainly depressed due to the current situations, empathy from the providers and psychiatrists would prove to be a great motivator for them and help them out in their time of need (Eisler, 2007). Physicians should also involve the patient and/or their families into devising a treatment plan, which is acceptable by both of them. There might be some intricacies faced by the patient such as financial issues or certain agendas which should be discussed and taken into account while formulating the treatment plan with the patient (Jin et al., 2007). Especially when the families show support by getting involved with the patient and their illness, it gives an encouragement to the patient and motivates them to follow the program better. Also, improving patient’s health literacy would give them a higher and positive attitude towards taking their medication, as it is taken as a challenge by most of the patients. This way the patient will understand themselves and realize the importance of taking in their medication. Inform them of the consequences that will occur if the medications are stopped improperly. Teach the patient to self-monitor their own behavior towards complying with the prescription and their mental illness. Due to this the patient will take more interest in his own restoration to health and will develop a sense of ownership and a heightened responsible attitude which will in effect increase compliance by the patient. Lastly, the addicts generally suffer from both psychotic as well as addiction disorders; therefore, it is better for the psychiatrists to treat both of them at the same time (Forster, 2009). Also, if the symptoms are confusing than the patient should be kept away from substances; it will make it easier for the psychiatrist to unravel and decipher the disorders within. References Eisler, P. (2007, January 16). New Orleans feels pain of mental health crisis. USA Today. Retrieved Nov 15, 2010 from http://www.usatoday.com/news/nation/2007-01-15-katrina-mental-health_x.htm Farris, M. (2010). Mental health system in N.O. still healing post-Katrina. WWL-TV, Inc. Retrieved November 16, 2010 from http://www.wwltv.com/news/local/Mental-health-system-in-NO-still-healing-post-Katrina-101518309.html Foster, L. (2009). How mental illness and addiction influence each other. Retrieved November 16, 2010 from http://www.everydayhealth.com/addiction/mental-illness-and-addiction.aspx Jin, J., Sklar, G. E., Oh, S. M. V. and Li, S. C. (2008). Factors affecting therapeutic compliance: A review from the patient’s perspective. The Clin Risk Manag, 4(1), 269-286. Polgar, M. (2010). Compliance. Retrieved November 15, 2010 from http://www.minddisorders.com/Br-Del/Compliance.html Ruetsch, C. (2010). Practice strategies to improve compliance and patient self-management. J Manag Care Pharm, 16(1-b), 26-27. Read More