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Medication refusal among patients treated in a community mental health rehabilitation service

Wotton Lawn, Horton Road, Gloucester GL1 3PX;

Minh Alexander, Senior Registrar in General Psychiatry

Royal United Hospital

W. Jerrom, Head of Clinical Psychology Services

United Bristol Healthcare Trust, Barrow Hospital, Bristol

^* Correspondence

Aims and method This study aimed to examine medication refusal and its associated variables in a representative sample of patients on the Gloucester rehabilitation service case register. One hundred and seventy-four of 199 patients on the Gloucester rehabilitation register were surveyed. Insight, cognitive function, knowledge of treatment, psychopathology and patient satisfaction were independently rated.

Results Thirty-five per cent of patients had refused treatment in the past month. Negative attitudes to treatment and historical indices of non-compliance were associated, identifying a consistent core of patients at continuing risk of refusal. However of refusers, 84% were persuaded within one month to take treatment, mostly by their community keyworker. Treatment refusal was associated with diagnosis of affective disorder, higher Brief Psychiatric Rating Scale score and failure to use a dosett dispenser, but not with insight, cognitive function, satisfaction with treatment, knowledge of treatment, a range of illness and demographic factors or any particular treatment type.

Clinical implications Drug refusal was evidently mostly managed by community keyworkers, and without recourse to the Mental Health Act. Simple techniaues such as the use of dosett dispenser may be valuable. Problems of communicating with the severely mentally ill about their long-term treatment were discussed.