"..it depends on the risk." Constructing 'Antipsychotic' Medication 'Refusal' in Community 'Mental Health' Services

Abstract

Aim Antipsychotic medication is the predominant intervention used for psychosis in the UK. However, there are risks associated, it is not always effective and service-users express ambivalence towards taking it. The research aims to explore community mental health professionals’ perspectives on working with people with psychosis who express antipsychotic ‘medication refusal’.

Method A mixed-methodology was utilised. A survey of community mental health professionals was undertaken (N=74) to enquire about frequency of medication refusal and actions taken by professionals. Four uni-professional focus-groups were held to discuss the topic. The resulting data was subjected to a discursive analysis.

Findings Antipsychotic medication refusal was presented as a common experience by participants, with service-users often stopping against advice. A substantial proportion of survey participants reported experience of supporting service-users without using antipsychotics or to come off, with good rates of success. ‘Risk talk’ was a prevalent feature of the focus-groups: a range of ‘risk’ repertoires were drawn on by participants to warrant particular actions.

Implications Government initiatives relating to service-user choice, empowerment and recovery in mental health are in opposition to more pervasive ‘risk’ discourses. The notion of ‘risk’ in relation to antipsychotics needs further consideration, with professionals made more aware of its social construction and alternative conceptualisations of psychosis and antipsychotics.