Jennifer Gazda, LCSW
Martha Kern

Angie was living in her car when we first met her.

Having been evicted from a subsidized apartment for disruptive conduct, and having seen a brief stint in her father’s home culminate in police intervention, Angie had run out of places to go.

Angie has experienced over 30 psychiatric hospitalizations in the 15 or so years since her schizoaffective diagnosis in college.  She has been arrested for an array of minor crimes.  She is denied visitation with her two children. Her relationships are damaged and her environment a mess.

These setbacks revolve primarily around Angie’s refusal to take her medications as directed by her psychiatrist.  She often stops them, or adjusts the dose, based on her own judgments that the medication is unnecessary or wrongly prescribed.

Many of us hear a story like this and think, “I would just take the medication.  It can’t be that bad.”  It’s somewhat more complicated for those whose judgment and insight are heavily colored by mental illness.

Side Effects
Cyclical compliance with medication regimens is a common pattern with those combating mental illness.  A period of compliance is often followed by a period of non-compliance.  Sometimes, a person with mental illness comes to believe he/she is better and that the medications are no longer needed; they stop using their medications, overlooking the fact that they are feeling better because of the medications.business_dress_shrugging_1600_clr_14230

The medications often produce side effects that are troubling to the patient.  In Angie’s case, the prescriptions caused her to feel her heart was racing, or induced an overall sense of discomfort.  She would point to these symptoms as the reasons she abandoned her medications.

It may well be, however, that Angie’s illness prevents her from understanding that she is truly ill.  It is also the case that having to rely on medication to remain functional is not a circumstance anyone prefers, particularly when the reason for that medication is psychiatric in nature.  Some people suffer shame and embarrassment over their mental health diagnoses and want nothing more than to be “normal”. Discontinuing the use of medication may feel like a step in that direction.

Another of our clients candidly shared that his medications silenced his voices, and he missed the voices.  They were his “friends”.  They accompanied him everywhere and probably provided a great deal of entertainment.  He preferred the voices to the tranquil company of medication.  Angie may or may not feel this way about her voices, but it seems possible that other clients feel bereft or even bored when all the drama of mental illness settles into quiet functionality.

Structure and Rewards
Angie’s years as her own medication manager came to an end shortly after we began to work with her.  Because of her lengthy history of non-compliance and the multiple hospitalizations that resulted, her doctors determined during her most recent hospital stay that she would be a good candidate for a long-lasting, injectable anti-psychotic medication.  The injections last for a full month and, to date, Angie has been open to receiving them.

Another change revolved around her housing.  Lifecare Guardianship was named limited guardian of Angie and, after she was stabilized at the hospital, we placed her in a facility equipped to manage her illness.

The facility offers continuous supervision, group therapy, activities, companionship and an array of other benefits.  It is a structured environment. Angie has done well there for relatively long periods of time.  She is rewarded for this with increased privileges.  While granted greater freedom, however, she was found outside at 4:00 a.m., having climbed out a third-floor window onto the fire escape.

It is, indeed, an up and down process.

The Road Ahead
Despite Angie’s complex and uneven history, and her continued pattern of advances and setbacks, we remain hopeful for her future.  We have worked with individuals whose mental illnesses were just as serious as Angie’s, and which triggered a host of difficult behaviors like hers.  Many were under guardianship.  After a period of years, a few of these clients have improved to such a dramatic degree that their guardianships have been dissolved and their rights restored.

Medication non-compliance is a part of many stories. It is not insurmountable, as seen with other clients, and we will work toward Angie’s gradual liberation both from the constraints of her illness and from the limits presently put in place to keep her safe.

© Lifecare Innovations