Date of Award
Doctor of Social Work (DSW)
Phyllis Solomon, Ph.D.
Abraham (Rami) Rudnick, MD, PhD, CPRP, FRCPC
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.
Ben Avraham, Lior, "Understanding Medication Adherence Among Individuals with Severe Mental Illness: Relationship to Treatment Approaches" (2020). Doctorate in Social Work (DSW) Dissertations. 151.