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Complex Mental Health


Table of Contents

Introduction. 2

Main context 2

Strategies to promote the administration of regular medication. 2

Case study. 3

Mental Health Act 1959. 4

The right of the patient to refuse treatment 4

Exceptions. 5

Conclusion. 6

References. 7


Pharmacological treatment is necessary for alleviating psychotic symptoms. Antipsychotic medications are effective in persons having schizophrenia. Non-adherence to medicines can happen for numerous reasons like forgetfulness, economic constraints and lack of acceptance for medication. Adherence to medication is a complex phenomenon involving environmental, medication-related factors and patients related factors.

Patient-related factors include newly started treatment, young age of the patient, alcohol addiction, low social involvements and economic constraints (Engdahl, 2010). Poor medication adherence is also exhibited by minority ethnic groups. Non-adherence can also be caused by a lack of family support. Adherence is influenced by medication and perception regarding illness. Medication adherence is more among patients who are aware of their illness and wants to avoid hospitalization.

Favourable results and no intolerable side effects are the main cause of medication adherence. The cardio-metabolic problem has prompted health staffs to focus on treatment and medication adherence of the population. Partial lack of adherence or complete lack of adherence has caused several negative results. The bio-psychosocial model is used by Psychiatric nurses. This model includes client education and spiritual support to the client. To improve treatment follow up decision-making strategies should be adopted regarding medication and behavioural therapies.

Main context

Strategies to promote the administration of regular medication

The specific problems relating to adherence can be solved by various available support services. Counselling is provided by therapeutic support service. The negative perceptions and inaccurate beliefs regarding medication can be removed by cognitive-behavioural therapy. Cognitive-behavioural therapy is often used in motivational interviewing. Motivational interviewing enhances the confidence required to adhere to the medication routine. Compliance theory includes cognitive-behavioural therapy, psycho-education and motivational interviewing. Non-adherence to medication is associated with a high risk of rehospitalisation (Delafon et al., 2013).

Schizophrenic patient requires antipsychotic medication and therapies to maintain symptoms under control. Psychiatric nurses can take steps to improve medication adherence and positive results using decision-making techniques that enable patients to participate in the decision making process regarding their treatment. For reducing relapse risk continuous treatment with antipsychotic medication is required for the schizophrenic patient.

The etiology of schizophrenia may include environmental, genetic and neural components. Antipsychotic medication affects neurotransmitter receptors. In the earlier medical model, the client has to comply with the medication recommendations and have no role in decision making. After the president's new commission on mental health, the decision-making concept has gained momentum. In the year 2005, the recovery model was incorporated in psychiatric service under the American Psychiatric Association (Jimu & Doyle, 2019).

The psychiatric nurses association collaborated with mental health service association and the substance abuse to transform the recovery concept. Through the recovery process, the clients improve their wellness and health. Self-directed life is accompanied by a sense of responsibility and empowerment. Clients want to get more involved in mental health treatment. The nurses may preach that lack of medical follow up can lead to hospitalization, relapse, criminal arrest, and suicide. This leads to frequent disruption in relationships and poor living quality (Latha, 2010).

A review team will analyze the various factors that lead to poor medication adherence like lack of access to health care facilities, cognitive deficits, comorbid substance abuse, economic constraints and lack of social support. A weak therapeutic alliance can also cause medication non-adherence. Therapeutic alliance is the relationship between the client and the medication provider.

The therapeutic alliance is of great importance as it engages in bringing change in the client that is beneficial. Nurses play a very important role in medication follow-up by identifying the hindrances and effective strategies that can be followed. The nurse has an extensive contract with the clients and is the first to detect non-adherence to medication (Molloy, Field, Beckett & Holmes, 2012). It is important for nurses to understand the treatment goals and to give priority to personal preferences and explain adverse events.

Case study

Sam a white male was psychotic, delusional and paranoid.  He could hear different voices which rather than helping him is troubling him. His apartment burned as he got distracted by those voices. He is of view that he has no privacy as someone is spying on him continuously. Sam works in a medical coding company but those voices are even interrupting him at his workplace. Sam has no family history of schizophrenia. His sleeping habits and appetite are normal.

Sam also did not have any suicidal tendencies or any tendencies to harm others (Usher, Baker & Holmes, 2010). Sam has admitted to having social anxiety. Sam uses drugs and intakes alcohol. Sam was diagnosed with schizophrenia and decided to take oral olanzapine. Though he sometimes forgets his medicines, he has admitted that his health has improved after taking medications.

Sam is distressed because of weight gain followed by medication. As Sam did not have a family to remind him to take regular medical doses he switched to LAI antipsychotic. Sam receives weekly phone calls from his nurse, who in turn reminds him for his follow-up appointment. Sam admits of running with his dog to keep himself fit and listening to songs as his personal medicine. Sam’s health has improved a lot after medication (Vuckovich, 2009). 

Mental Health Act 1959

This act was incorporated with a view to end the distinctions between all mental health care units and to ensure that the mental patients are treated by the community care. This act distinguishes learning disability from mental illness. The act was enacted with a view to incorporate a number of changes. The changes are to make the treatment procedure voluntary and informal, where it is compulsory to undergo treatment a proper legal framework must be designed as a medical decision, where possible to move the treatment from institutional care to community (Legislation, 2018).

This act repealed the other two acts namely Lunacy and Mental Treatment Act and the Mental Deficiency Act. The category of moral imbecile was termed vague and abolished in the act. The two main principles of this act are to provide voluntary treatment as much as possible in hospitals or communities on a voluntary basis and to apply compulsion on the residuary community in the greater interest of the society. In the first principles, the procedural formalities existing before have been removed (Eby & Brown, 2009). The function of the board of control was transferred to the ministry of health, local authorities and health review tribunals.

The right of the patient to refuse treatment

Patients have both the right to treatment and the right to refuse treatment. Any person who voluntarily enters the hospital and pose no risk to himself or others’ can express his right to refuse treatment and leave the hospital premises. The right to refuse treatment is also applicable to psychiatric treatment. The right to treatment has been formulated by the court keeping in mind facts from previous cases where people in psychiatric hospitals were left without treatment for many years (Garman, Johnson & Royer, 2011).

After the incorporation of the right to treatment law, the patients in public psychiatric hospital have to right to receive the same standard of care as expected from an accredited psychiatric hospital. The right to refuse treatment is also a legal requirement for psychiatric treatment. No person can be involuntarily admitted to a hospital for accessing treatment. No health staff can treat a patient against their will unless there is a court order in this regard.

The right to refuse treatment is based on the right to privacy, equal protection and due process of law. Patients have the right to take a decision regarding their bodies. The right to refuse treatment can result in patients being locked up in hospitals rooms and insurance companies denying the claim of the patients as there was no treatment. The state psychiatric hospitals cannot refuse treatment to anyone who cannot afford the payment.


There are certain exceptions to the right to refuse treatment. In an emergency situation, the doctor may administer drug involuntarily to control the emergency situation. When there is an imminent danger to the patients or others the doctor may provide emergency medication to tackle the situation. After the emergency period, the doctor has to take consent of the patient to continue treatment. Even if there is a possibility of another emergency situation the doctors must take patient’s consent before treatment (Levin, Hennessy & Petrila, 2010).

The hospital may take court order in order to commence an involuntary treatment of the patient. The judge after taking into consideration relevant facts and issues will determine whether or not such treatment is necessary for the benefit of the patient.

Patient under medication is exposed to both harms and benefits. Benefits received are the management of the disease and progression in the disease. Harm can be caused by medication error like the wrong dose and the wrong time. Nurses face the challenges of providing the right medication to the patient at the right time. Medication errors in intensive care units and emergencies can cause an adverse drug event or death.

Wrong dose and wrong route of administration is the most common type of medication error. Medication error is quite hard to detect and as a result, effective strategies to prevent medication error has not evolved. To improve adherence medicines are sometimes administered in a hidden way in food. Covert medication touches patient autonomy and competence (Morkunas, Porritt & Stephenson, 2015). Covert medication breaches ethical practice and trust in the patients. Covert administration of the drug is used as a last resort in the best interest of the patient.

The nurses can remind the patient regarding any follow-up. Non-adherent patients should be given information regarding how medicines cure their disease. The nurses can change the way in which the medicine is administered to them if felt uncomfortable by the patient. Non-adherence tendency is mostly seen in young adults who drop out of their medication routine. They should be given proper information like non-adherence can increase the gravity of the disease and will subsequently lead to rehospitalisation.

Non-adherence to medicines can be for numerous ways and when non-adherence is for economic constraints the nurse can suggest the patient take treatment in state psychiatric hospitals as state psychiatric hospitals do not refuse treatment to anyone who cannot afford the expenses of treatment (Taylor, 2015). The nurses should personally contact the patients to inform them regarding their follow updates in the clinics.

In case no other way is working out the nurse can take resort to Covert medication which is the last resort. In convert medication, medicine is administered to patients without his knowledge. When a patient is ill to such extent that he cannot distinguish things the health care centre can take permission from the court for conducting treatment to such patients. Without such permission, no involuntary treatment can be carried out (Grice & Meehan, 2016).


There are many strategies that are evolving to improve the process of treatment in mentally ill patients. This improved strategy focuses on practical methods to cope up with the emerging problem. To ensure implementation of this strategy the health workers must involve and engage themselves with the process.

The nurses should be flexible regarding their shift timing and delivery of the health care services. The nurses should be dedicated to improving the health and well being of the mentally ill patients. Concerted efforts have to be made by the nurses to address fear, misconceptions, constraints, and stigma that will in turn help in transforming and improving the mental health system of the population.


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  • Eby, L., & Brown, N. (2009). Mental health nursing care (5th ed.). Upper Saddle River, N.J.: Pearson/Prentice Hall.
  • Engdahl, S. (2010). Mental health (4th ed.). Farmington Hills, MI: Greenhaven Press/Gale Cengage Learning.
  • Garman, A., Johnson, T., & Royer, T. (2011). The future of healthcare (5th ed.). Chicago, Ill.: Health Administration Press.
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  • Lamb, H., & Weinberger, L. (2017). Understanding and Treating Offenders with Serious Mental Illness in Public Sector Mental Health. Behavioral Sciences & The Law, 35(4), 303-318. doi: 10.1002/bsl.2292
  • Latha, K. (2010). The Noncompliant Patient in Psychiatry: The Case For and Against Covert/Surreptitious Medication.
  • Legislation. (2018). Mental Health Act 1959. Retrieved from
  • Levin, B., Hennessy, K., & Petrila, J. (2010). Mental Health Services (3rd ed.). Oxford: Oxford University Press, USA.
  • Molloy, L., Field, J., Beckett, P., & Holmes, D. (2012). PRN Psychotropic Medication and Acute Mental Health Nursing: Reviewing the Evidence. Journal Of Psychosocial Nursing And Mental Health Services, 50(8), 12-15. doi: 10.3928/02793695-20120703-03
  • Morkunas, B., Porritt, K., & Stephenson, M. (2015). Retraction notice: The experiences of mental health professionals' and patients' use of pro re nata (PRN) medication in acute adult mental health care settings: a systematic review protocol of qualitative evidence. The JBI Database Of Systematic Reviews And Implementation Reports, 13(7), 153. doi: 10.11124/jbisrir-2015-2494
  • Taylor, C. (2015). Fundamentals of nursing (6th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
  • Usher, K., Baker, J., & Holmes, C. (2010). Understanding clinical decision making for PRN medication in mental health inpatient facilities. Journal Of Psychiatric And Mental Health Nursing, 17(6), 558-564. doi: 10.1111/j.1365-2850.2010.01565.x
  • Vuckovich, P. (2009). Strategies Nurses Use to Overcome Medication Refusal by Involuntary Psychiatric Patients. Issues In Mental Health Nursing, 30(3), 181-187. doi: 10.1080/01612840802694478

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