The Experiences of Clients Prescribed Psychiatric Medication: A Need for Deeper Clinical Engagement

Background and Purpose: Psychiatric medications are an integral component of the interdisciplinary treatment of social work clients diagnosed with severe mental illness (SMI). Social workers are often closely involved with use of psychiatric medications, including referral, adherence, and psychoeducation. Despite the adoption of a recovery orientation on both the policy and practice level and an acknowledgment of the importance of consumer voice, there is a paucity of research that reports the experiences of consumers. This study sought to give voice to an unusual and under-studied subpopulation, individuals diagnosed with SMI who eventually experienced functional recovery. 

Methods: We used purposive sampling to recruit 16 participants in a metropolitan area in the Southwest United States. All had been previously diagnosed with SMI, and most participants provided documentation confirming their psychiatric history.  In-depth narrative interviews were conducted by two members of our research team familiar with qualitative methods. Participants were asked what role medication played in their recovery, as well as related questions. These 45-90 minute interviews were audiotaped, transcribed, and transferred to NVivo 9 for data analysis. Three members of our research team then analyzed these data utilizing open and secondary coding. We endeavored to reduce bias and manage research reactivity through several methods, including the use of an audit trail and member-checking after the initial interviews.

Results: Participants related nuanced accounts of their experience of taking psychiatric medications, including both positive and negative aspects. Most reported medications as their primary intervention. Comprehensive and time-intensive clinical engagement regarding medications on the part of helping professionals was unusual but highly valued; a collaborative approach which included consumer input was highly preferred. In-depth interactions with highly engaged clinicians were highlighted as especially helpful. Informed consent was often lacking within clinical interactions. Trial-and-error testing of various medication combinations over time was the norm. Some participants reported that taking a specific medication regimen was the key to their functional recovery, while others reported that discontinuing a medication (i.e., a first-generation antipsychotic) was crucial. Adverse effects were commonly experienced, including akathisia/agitation, sedation, weight gain, and sleep difficulties. Some participants reported worsening symptoms on specific medications, and were frustrated that this was not always accepted by clinicians.  Participants also reported the helpfulness of medication prescription patterns congruent with self-determination (e.g., selective medication models), and the importance of also addressing psychological trauma.

Implications: These consumers had all attained functional recovery, an unusually positive outcome. Thus, their experiences and insights could have utility, particularly on the issue of clinical engagement. Social workers have a role in facilitating and providing increased clinical engagement in practice settings. This is not only consistent with the values of the social work profession, but also congruent with the shared clinical decision-making movement gaining ground in general medicine. There are limitations to this study, and future work should further investigate these issues. However, as recovery-oriented and consumer-centered services expand, the integration of consumer voice into the use of psychiatric medications could result in more collaborative, and possibly more effective, mental health treatment.