Sunday, September 12, 2010

"You'd Feel Fine If You Only Took Your Medicine"

I take my medicine.  Do you?  Probably.  So why is it so hard for our loved ones with mental illness to take their meds? You probably have heard all the reasons:

  1. They hate the side effects.
  2. They feel good now so they hope that the illness is over.
  3. It's too hard to get the medicine. 
  4. The medicine takes aways the "highs," leaving them flat and uncreative.
  5. They just don't like the idea of taking drugs for mental illness, athough they often medicate it themselves with alcohol and street drugs.
  6. The medicine is too expensive. (That's certainly true.)

The No. 1 responsibility that we have as caregivers is to make sure that our loved ones get and take their medication. That's difficult, to say the least. I have had a variety of experiences.  I've had loved ones actively refuse to take the medicine, spitting it out into the glass of water.  I've had loved ones pretend to take the medicine and later throw it into the toilet.  And I've had loved ones faithfully take the medicine.

This last came as a result of refusing to provide any money to the loved one and then offering to trade compliance for cigarettes.  Yes, I know the American Lung Association would be proud of me. But it worked.  And, since up to 80 percent of people with schizophrenia smoke, it is an option. Once he had been on the medicine for a while, he became faithful about taking it because, he said, "I remember what it's like when I don't take my medicine."

Frankly that's what we all wish for.  Of course, the classic strategies to encourage compliance include:

  • Talking up the benefits of taking the medicine, including pointing out that it will help them to stay out of the hospital. A locked psych ward isn't a pleasant memory for anyone.  Pointing out that the medicine will help them move forward to better days is also important. 
  • Building the medicine into a routine that's as simple as possible.  We do a weekly pill box.  I fill it each Sunday and check it intermittently. My loved one also takes all the medicine once a day, even though he is supposed to take it in 12-hour periods.  He was never able to remember taking it in the morning, but could remember to take it before bed. Better all at once than not at all.  
  • Using incentives, like money, movie tickets, keys to the car and other things.
If they still won't take the medicine, you need to maintain as positive and pleasant a relationship as you can so the tension of the medicine doesn't destroy your rapport.  At the same time, you need to allow the loved one to experience the consequences of not taking the medicine. And that can be the most difficult step of all. 

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