Psychiatrists’ reflections on a medication-free program for patients with psychosis

Abstract

Background: Based on a collective action from a number of Norwegian user organizations for mental health, the Norwegian government demanded the regional health authorities to establish a medication-free treatment option for patients with severe mental illnesses. This change in governmental health policy has several direct implications, including making antipsychotic medication to a greater extent optional for patients with active psychosis. Aims: The sim of this study was to investigate psychiatrists’ reflections on the public medication-free program and how they think it will affect patients’ adherence to antipsychotics generally. Method: We used a thematic analytic approach within an interpretative phenomenological framework. Consecutively semi-structured qualitative interviews were conducted with 23 psychiatrists (16 female, with 4–35 years of specialist experience). Results: Thematic analysis revealed four main interrelated themes. Psychiatrists considered medication-free treatment as an unscientific option for a stigmatized patient group; they believed that the advent of such a program is due to proposals from some dissatisfied users and their supporters and not from the majority of patients; in spite of active psychotic symptoms and lack of insight, patients had a crucial impact on choice of treatment and accordingly on adherence to medication; and psychiatrists reported that they in spite of governmental instructions utilized professionalism against unscientific ideology. Conclusions: Despite all the internal and external pressure that the psychiatrists reported being exposed to, this did not affect their professional integrity in medical decisions based on guidelines, expertise and research studies. They believed that this treatment option would exacerbate negative attitudes towards medication and further worsen already existing adherence issues.

Why Service Users Choose Medication-Free Psychiatric Treatment: A Mixed-Method Study of User Accounts

“…This contradicts the views of MFT as representing the wish of only a minority of service users. 26 It also contradicts the view that service users already have a crucial impact on choice regarding medication. 26 …”

“… 26 It also contradicts the view that service users already have a crucial impact on choice regarding medication. 26 …”

“…Lack of respect for not wanting medication was a common experience in recent treatment, and it can be difficult to quit medications without help. As shown by Yeisen, Bjørnestad, Joa, Johannessen, Opjordsmoen, 26 some clinicians consider MFT unprofessional, unscientific, harmful, and unethical. Service users report strong informal pressure for medication during previous admissions, mirroring the staff sentiments found by Yeisen, Bjørnestad, Joa, Johannessen, Opjordsmoen.…”

“…Service users report strong informal pressure for medication during previous admissions, mirroring the staff sentiments found by Yeisen, Bjørnestad, Joa, Johannessen, Opjordsmoen. 26 Notably, one of our interviewed participants seeking alternatives conveyed that medication was the only thing she had been offered, and alternatives had never really been discussed. Some of our interviewed participants who said they had been respected simultaneously conveyed that the respect was due to their own determination, strength, and/or knowledge.…”

Clinicians’ views of treatment types for first episode psychosis delivered in a randomised controlled trial (MAPS)

“…For example, a recent UK qualitative study identified factors underpinning prescribing behaviour that include prescribers’ level of experience, varying levels of perceived personal responsibility for prescribing and associated risks, collaboration and compromise, patient involvement, and research evidence [10] . Notably, a Norwegian interview study examining psychiatrists’ views of medication-free treatment for psychosis reported substantial concern among prescribers that justifying treatment without antipsychotics lacked evidence [11] .…”