Perspectives on Psychiatric Medication in the Context of Person-Centered Care

Background and Purpose:

The use of psychiatric medication is a common part of mental health treatment, with 16% of U.S. adults filling a prescription for a psychiatric medication in 2013.  Yet many people receiving services do not adhere to medication and treatment dropout is high due to people not feeling listened to or included in decisions about their treatment. Research has found that giving people more choice can result in improved clinical outcomes and treatment satisfaction. In response, agencies are adopting a more person-centered approach, promoting shared decision making and services that are responsive to people’s preferences, needs and values. With the aim of understanding person-centered care as it relates to psychiatric medication, this qualitative study explores provider and service user perspectives on psychiatric medication when implementing a person-centered intervention.

Methods:

The study setting consisted of community mental health clinics (CMHCs) participating in a large NIMH-funded randomized controlled trial of Person-Centered Care Planning (PCCP). Person-centered care planning targets the treatment planning process as a critical mechanism for delivering recovery-oriented services. Twenty-two focus groups with 193 total participants were conducted with providers and service users from the seven CMHCs trained in PCCP. Seven focus groups were conducted with supervisors (n=40), eight with direct care staff (n=64) and eight with service users (n=89)   Focus groups explored participants’ experiences implementing or receiving PCCP. Thematic analysis was employed with two researchers inductively coding data related to psychiatric medication. The codebook was created and revised through an iterative process. A third researcher assisted in the final phase of the coding process with any inconsistencies in coding resolved through consensus.

Results:

While participants valued collaborative service planning and the sharing of treatment decisions, they were less likely to apply these person-centered perspectives to psychiatric medication. The following themes emerged from the analysis: medication as a precondition to person-centered care and one-size fits all medicine. Participants described taking psychiatric medication as necessary for managing symptoms and as a precondition for person-centered care to take place. Providers described their primary role surrounding the use of medication as promoting adherence. Service users described it as “doing the right thing” and “staying out of trouble.” When working with prescribers, participants described a one-size fits all approach to medication in which care was not collaborative or personalized. There were some counter-examples when providers saw medication as a choice to be used to achieve a person’s life goals and treatment was collaborative.

Conclusions and Implications:

While a person-centered approach was adopted for most aspects of treatment, psychiatric medication use was the exception. Psychiatric medication use was viewed as necessary for recovery and for person-centered care to occur. This indicates a need to target medication use in future person-centered training initiatives.  Person-centered care emphasizes a person’s strengths and the pursuit of life goals over symptom management. While the very nature of this practice can reduce symptoms, necessitating medication and symptom reduction for person-centered care to occur conflicts with the values of this practice.