Reasons for Non-Adherence


A survey of ‘service users with schizophrenia or bipolar disorder’ by London’s SANE mental health charity finds that 77% of responders identified themselves as being non-adherent to prescribed treatment, with 29% being satisfied with the results.  Side effects and quality of life were mentioned as factors in non-adherence. “Participants wanted more information about their medications, better emotional support (including better access to psychological therapies) and stability in their relationships with health professionals.”

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Gibson, S., Brand, S., Burt, S., Boden, Z., Benson, O; Understanding treatment non-adherence in schizophrenia and bipolar disorder: a survey of what service users do and why. BMC Psychiatry, online May 29, 2013

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Kermit Cole
Kermit Cole, MFT, founding editor of Mad in America, works in Santa Fe, New Mexico as a couples and family therapist. Inspired by Open Dialogue, he works as part of a team and consults with couples and families that have members identified as patients. His work in residential treatment — largely with severely traumatized and/or "psychotic" clients — led to an appreciation of the power and beauty of systemic philosophy and practice, as the alternative to the prevailing focus on individual pathology. A former film-maker, he has undergraduate and master's degrees in psychology from Harvard University, as well as an MFT degree from the Council for Relationships in Philadelphia. He is a doctoral candidate with the Taos Institute and the Free University of Brussels. You can reach him at [email protected].


  1. Just want to point out that changes in attitudes by many professionals kind of makes the diagnosis of schizophrenia to be nonsense, and so non compliance with the brain destroying drugs for a non disease makes a ton of sense.
    I was someone who was locked up in an American state hospital with the diagnosis of chronic paranoid schizophrenia. I objected mightily but it was years later when the diagnosis of ptsd came into being, and almost overnight the diagnosis went away. Just suggesting that those who are buried under psychiatry might look at the fact that there is a great possibility they have no such “illness”, but were trained to be dysfunctional.
    Hugh Massengill

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  2. Conclusion: “Whilst medication non-adherence carries serious risks for service users, more than half of service users taking medication for either schizophrenia or bipolar disorder do something different to their treatment recommendations.”
    SANE reported no competing interest. Really? Does that mean that SANE’s ‘support’ from Lundbeck pharmaceuticals (who happen to make medication for depression, schizophrenia and bipolar disorder) is not regarded as a conflict of interest? I would take any SANE report with a grain of salt!

    SANE previously made a statement following the suicide of Lord Milo Douglas:

    Interestingly, they never mentioned the fact that Lord Milo had recently been prescribed Citalopram/Celexa (made by Lundbeck) which double the risk of suicide. The conflict of interest here is mind-boggling! I did broach the subject but they ignored me..
    Leonie Fennell

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  3. I am so glad ‘service users’ was in quotation marks in the headline. That mind bogglingly statist, Orwellian term needs to be quarantined in quotation marks wherever it rears its ugly head.

    ‘sectioned’? Oooohh….. dadedadada… don’t mind me… just ‘using’ a government ‘service’ over here. Just ‘using’ it, it was ‘available’ and the police kindly helped me ‘use’ it. Oh yeah.

    You see those people behind that locked door? Those people we signed CTOs for? Oh they are people who ‘use a service’. Yep. You see that person being dragged kicking and screaming into the facility? Oh he’s using a service. There’s a service there, and he’s using it. Later we’ll survey this ‘service user’ and we will diligently produce a SANE report, indicating what these people who ‘use services’ think of some issue related to the ‘service they use’. And we will type it, and say it, with a straight face, for we are not indoctrinated into the use of scary cult-like language that masks the inherent coercive nature of the ‘service’ we work in at all.

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  4. I’m not from the UK, but felt an uneasiness after reading this article, highly suspecting SANE has ties to pharmaceutical money.

    In spite of knowing very little (other than what a Brit told me about the organization on a phone call some time back…),I’m impressed with the UK charity Mind – their decision to post a very good article on psychiatric drug withdrawal…

    One that points out how many folks receive little or no support from their doctors with this decision, and taper with the information at hand, support of peers, etc. –

    I thought this was one of the biggest risks I’d seen taken by any charity.

    It’s good to know so many Brits are taking part in this revolution, so many folks from around the world!

    Duane Sherry
    Texas, USA

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  5. And yet despite their biases, they still found that the main reasons for “non-adherence” (glad they used that term, rather than “noncompliance”) were dissatisfaction with results or intolerability of adverse effects. Not “Anosognosia” or thinking they’re better so they don’t need them any more. They are interested in QUALITY OF LIFE, and if the drugs don’t improve or reduce their overall quality of life, people are likely to discontinue. That over half of those so treated find their quality of life the same or made worse by the drugs should give the prescribers pause. Instead of trying to force them into agreeing with their treatment, maybe they ought to ask them why they stopped? Radical thought, I know…

    —- Steve

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