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Medication adherence particularly hard for the mentally ill

Crisis Services head Douglas Fabian says medication noncompliance often results in the mentally ill being hospitalized.

Scott Scanlon – Refresh Editor

Anyone who’s ever spent time visiting a mental health unit across the country has overheard others having the same type of conversation they are having with the loved ones they’ve come to see.

At some point, you hear something along the lines of, "I know you don’t want to be here, and you wouldn’t be if you had taken your medication like you were supposed to."

Psychiatric conditions can be tricky, and medication effectiveness can vary over time, and depending on other factors, but people with these conditions often start feeling better and stop taking their prescription drugs because they wrongly believe they no longer need them, or prefer not to deal with the side effects.

“I hear from doctors and psychiatrists and people in the field that we have come so far in terms of medication that if people would just take the medication, many of their problems related to their psychiatric disorder, or their behavior problems, will be taken care of,” said Douglas Fabian, executive director of Crisis Services in Erie County.

“Sometimes it takes a while for the medication to take effect,” Fabian said, “and sometimes people unfortunately want to go on holidays from their medication because they are feeling better. Therefore, they say ‘Maybe I can cut that pill down. Maybe I can personally take control of this and in some way self-medicate,’ and that doesn’t work.

“Once people start to modify their prescription, there’s a 50 percent chance they’ll end up in a hospital if their psychiatric disorder is a significant one.”

The lack of medication adherence, subject of today’s cover story in WNY Refresh, is not only a problem for those with chronic mental health conditions. It’s a challenge for many with varying types of conditions, as well as folks with short-term maladies who don’t finish prescription medications as directed.

And it’s a challenge that should not be laid solely at the doorsteps of people who need to take prescription medications, said Scott V. Monte, owner of Mobile Pharmacy Solutions on the Buffalo Medical Campus.

"We talk about education but we need to understand better the support systems and motivations of patients,” Monte said. “I think we do a pretty poor job of that when we’re initially giving medication and counseling."

What pharmacists and doctors need to focus on up front, he said, is “What’s the rationale for staying on these medications long-term? Just like everything in your life, if you don’t believe in it, it’s not something you’re going to pursue."

The elderly, and the chronically ill, need all the education they can get from their pharmacist, Monte said.

"If you’re at five, six, seven, 10 medications, it gets increasingly complex to organize it and be motivated to take them all."

Monte said he started the mobile pharmacy in 2009  to deal with such complexities. Going into a home and sitting down at dining room table is "a completely different look," he said.

"You understand their living situation. Sometimes medications are problem number six."

Pharmacists in such cases also can ask patients to gather other supplements, herbal medications and over-the-counter drugs to see if any don’t mix.

"You just don’t have that luxury at the pharmacy," he said. "A lot of times, patients don’t know the names of the medicines they’re on, why they’re taking them or the rationale."

That’s when those prescribed such medications need to ask questions until they do understand.

This can be a thorny proposition for those who have a mental health component to their illness.

When it comes to mental health disorders, Fabian said, “From the very beginning there’s a good percentage of people who are reluctant to start on medication. It’s the beginning of a road that could be long-term and even lifetime, and so they’re reluctant to start.”

There’s also a stigma that comes with taking medication, as well as the side effects, which can include lethargy and weight gain.

Fabian had encouraging news for parents and other family members who’ve watched loved ones in their late teens and early 20 struggle with the onset of mental illness.

One in five families will deal with such an illness, he said, so they need to understand they are not alone.

“It does get better,” Fabian said. “I know it sounds simple, almost trite, but it does get better. Sometimes you hear the term that young people ‘grow out’ of the disorder. I don’t know if they grow out, I just think they learn to live with it, and realize that it’s not debilitating, it’s not limiting, they can carry out their lives in a normal way – whatever normal is today – as possible.

“But unfortunately, just as someone might need a knee brace, they need the psychotropic medication.”

Here are tips he gave to those dealing with a chronic mental illness:

  • "I think you want to have a good, healthy relationship with your psychiatrist or doctor so, if you in some way want to challenge whether the medication is doing what it’s supposed to do, you can."
  • "The other thing I would strongly recommend is reaching out to people,. It could begin with a hotline." The Crisis Services line, at 834-3131, operates 24 hours a day. "Our staff is trained to handle everything from the suicidal situations to ‘I am just not feeling that well today and I think it’s my medication,’ Fabian said. “We run the gammut because those calls that seem less critical can mushroom.”
  • "People need to feel comfortable with where they are." They, and their friends and families can go to groups or individual counseling and plug into support from the Mental Health Association of Erie County and the local chapter of the National Alliance for the Mentally Ill.

Fabian added the Crisis Hotline is not only for those who are sick.

“If someone is bipolar or schizophrenic or depressed, that behavior can be very challenging, and that leads me into the fact that caregivers and parents need support. Where can they go when they need someone to talk to? That’s where we come in, too."


Twitter: @BNrefresh

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About The Refresh Buffalo Blog

Scott Scanlon

Scott Scanlon

Scott Scanlon is an award-winning reporter and editor who has covered various topics in his quarter-century as a journalist in South Florida, Syracuse and Buffalo. He is aiming to pass along what he is learning these days about health, fitness, nutrition and family life.

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