Service user and carer perspectives on medication compliance in mental health services: a qualitative study

• Main Author: Gault, Iris Isobel
• Published: St George's, University of London 2012
• Subjects: 362.2
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.589951

This qualitative study analyses mental health service-user and carer perspectives on medication compliance and experience of compulsory treatment. Data were generated from interviews and focus groups with twenty four mental health service users/carers with a history of repeated admission under the Mental Health Act (1983) due to medication non- compliance. The research is set against the background of changes to mental health legislation in England, including Supervised Community Treatment. It makes use of the data generation and analytical techniques of grounded theory. Analysis of data indicated considerable confusion and paradox in the policy and practice context of contemporary mental health care. Eight initial categories emerged from qualitative interview and focus group data. These were the experience of desperation meeting with what is perceived as professional indifference; loss of a credible identity; playing the game; medicalisation of experience; meeting therapeutic competence; enabling collaboration; or alternatively, meeting therapeutic incompetence; disabling collaboration. Findings suggest that service users are initially reluctant to comply with mental health medication, but eventually accept the need for treatment. They actively seek out services providing acceptable care but avoid those offering unacceptable care. Categories were subsumed into a core category of Negotiating the Janus Face of Mental Health Care to develop substantive grounded theory. This explains how mental health service users who have had compulsory treatment manage their experiences of positive or negative care. It stresses the significance of mutually respectful relationships with professionals and the importance of communicative competence. Macro and micro elements of these findings were further analyzed within the Habermasian framework; the Theory of Communicative Action, evolving into Negotiating the Janus Face of Mental Health Care to Locate Communicative Action. This explains how service users seek professionals working in communicative and collaborative mode. The thesis concludes by addressing implications and recommendations for policy, practice, education and research. Keywords: compulsory medication, coercion, medication, compliance, concordance, supervised community treatment and grounded theory.