Date of Award

Fall 12-22-2020

Degree Type

Dissertation

Degree Name

Doctor of Social Work (DSW)

First Advisor

Phyllis Solomon, Ph.D.

Second Advisor

Abraham (Rami) Rudnick, MD, PhD, CPRP, FRCPC

Abstract

Purpose: The use of coercion in public mental health programs as a means to promote adherence to psychotropic medication is a subject of significant debate. Programs that rely on coercion, such as involuntary outpatient commitment, are growing, while programs that reject coercion, such as recovery-based services, present an alternative agenda. Yet, scholarship has not examined recovery-oriented services and coercion together, as a way of explaining medication adherence. Thus, study tested the hypothesis that among consumers with SMI, the greater the degree of perceived recovery-oriented practices and the lower the degree of perceived coercive practices, the greater the degree of adherence to medication treatment. Method: Using an online survey, the study was completed by 111 adults who self-reported a primary psychiatric diagnosis of a severe mental illness and received psychiatric medication prescriptions from a community mental health clinic. The survey included measures of perceived autonomy, perceived organizational recovery-oriented services, perceived coercion, and adherence to medication. The research employed an explanatory mixed-methods (quantitative and qualitative) design. Hypothesis was tested using multiple regression and open-ended questions were analyzed using directed content analysis. Results: Autonomy was found to be a significant predictor of adherence to medication, while perceived organizational culture of recovery-oriented practices and perceived coercion were not significant predictors of adherence to psychotropic medications. Qualitative analysis demonstrated that participants viewed autonomous decision-making and person-centered care as effective methods to encourage adherence. Conclusion: Elements of recovery-oriented treatment that increase consumers’ sense of autonomy in decisions about medications will likely enhance their adherence.

Available for download on Friday, December 03, 2021

Included in

Social Work Commons

Share

COinS