N ON - COMPLIANCE IN MENTAL ILLNESS 1

P ARTICIPANTS Presenting author: Karishma Karim Halani Authors: Rabia Qasim Ali Salima Karani Reema Roshan Ali Husnia Jumma Khan Azada Hussain 2

ROAD MAP Basic concepts of non-compliance Causes of non-compliance Interventions and Recommendations to reduce non-compliance 3

D EFINITION OF NON - COMPLIANCE “Noncompliance is a deviation form or cessation of a treatment recommended by the provider. Noncompliance is more common in mental illness than other physical illness as mentally ill patients are often depicted as unusual and less proficient.”. 4 (Weiden & Rao, 2005)

T O WHOM IT IS A CONCERN ? Noncompliance is a crucial community health concern and may cause relapse and re- hospitalization. 5 (Weiden et al., 2005)

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C AUSES OF NON - COMPLIANCE Self-stigma - it is defined as “a devaluation of the self by internalizing negative stereotypes they attribute to themselves or/and attributed to them from external sources”. This stigma de-motivates person, bring low self confidence and reduces compliance. 7 (Fung et al., 2007)

C ONT.. Poor insight – it includes awareness of the disorder, need of treatment, specific signs and symptoms and the attribution of symptoms to disorder and understanding of the social consequences. 8 (Chakraborty & Basu, 2010)

C ONT.. Improper persuasion techniques and lack of family support. This brings feelings of detachment, isolation and negative attitudes. 9 (Rodgers & Butterworth, 2008)

C ONT.. Side effect of medications - a person who takes anti-psychotics can undergo drowsiness, restlessness, blurring of vision etc. Non- compliance also occurs due to difficult timing, delay in recovery and pessimistic approach toward medicine. 10 (National institute of mental health, n.d.)

C ONT.. Cost burden - noncompliance of medication and treatment occurs due to poor financial status. 11 (Lama, Lakshmi, Shyangwa, Parajuli, 2012)

C ONT.. Imperfect communication and client’s feeling of depersonalization - due to the power of control by healthcare workers. 12 (Schultz & Videbeck, 2009)

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Health care workers should deal stigmatized patients on individual basis instead of drawing conclusions through uniform experiences 14 (Pandya et al., 2010)

Psychoanalytic and psychodynamic therapists generally spend time listening to patients talk about their lives. The therapy provider will look for patterns or significant events that may play a role in the client's current difficulties. Psychoanalysis therapy helps to increase self- understanding and expand insight. 15 American Psychoanalytic association, (n.d.)

Interpersonal therapy that helps patients to develop their social interactions. 16

Psychiatrist should conduct workshops for family and healthcare workers to promote problem solving skills and appropriate persuasion techniques. 17

CBT is "problem focused" (undertaken for specific problems) and "action oriented" (therapist tries to assist the client in selecting specific strategies to help address those problems). CBT helps clients overcome their troubles by altering their ideas, behavior, and emotions. 18 Goals of cognitive therapy (n.d.)

DBT plans to build ‘acceptance techniques’ with ‘change techniques’. Acceptance behaviors encourage patient to identify negative behaviors from self and on the other hand, change behaviors encourage patient to modify that negative behavior 19 (Making sense of dialectical behaviour therapy (DBT), n.d.)

Nurses should assist patients to make association between noncompliance and exacerbation of symptoms as it may help client to jot down benefits of compliance. 20

Support client to verbalize feelings about illness and allow client to make some decisions related to his treatment as this can be a positive step to acknowledge his health condition. 21

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R EFERENCES Chakraborty, K., & Basu, D. (2010). Insight in Schizophrenia – A Comprehensive Update. German Journal of Psychiatry. Goals of cognitive therapy. (n.d.). Beck institute for cognitive behavior therapy. Retrieved from behavioraltherapy-goals/ Making sense of dialectical behaviour therapy. (n.d.). mind for better mental health. Retrieved from ternative_care/dialectical_behaviour 23

Psychoanalytic Psychotherapy. (n.d.). American psychoanalytic association. Retrieved from sychoanalytic_Psychotherapy.aspx Psychoanalytical and Psychodynamic Therapies. (n.d.). Counselling directory. Retrieved from oanalytical.html#PsyhodynamicTherapy Schultz, M., & Videbeck, L. (2009). Care plans. In Lippincott's Manual of Psychiatric Nursing Care Plans (8th ed., p. 53). 24

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