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.

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Social Work Commons

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