Improving Medication Concordance in Mental Health- a Review of the Literature

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Improving Medication Concordance in Mental Health- A Review of the Literature

Where a man is against his will, that to him is a prison. Epictetus


There has been much discussion on why concordance with antipsychotic medication and treatment appears to differ from other fields of medicine. Does the literature support this contention? This review aims to seek out best practice and apply the principle of informed choice in assessing concordance and using appropriate interventions to educate individuals with psychosis.

Abstract Introduction Compliance or concordance? Client centered therapy Administration of medicines and patient capacity

Competent or non-competent?
Schizophrenia in comparison with asthma and epilepsy
Negotiating medication
Antipsychotics- Hobson’s choice?
Education - the patient’s view
Psychosocial treatment interventions
Compliance therapy
Conclusion and Recommendations


The aim of this literature review is to identify if possible, what simple, easily introduced refinement may be useful on an acute mental health ward, with the aim of better understanding the factors affecting concordance with both medication and treatment provisions. The review of the evidence was necessarily broad, for two reasons. Firstly, the premise that concordance is poorer with mentally ill patients (Hughes, et al.1997, Marland and Cash, 2005), compared with those suffering from physical illnesses (although acknowledging the considerable over-lap). This premise has been personally encountered whilst on practice placements. Secondly, whether any advantage might be gained from other areas of practice and applied to the chosen patient group.

The literature search strategy was carried out by initially accessing the “Pub med” and “Ovid” databases, using the terms “concordance”, “compliance” and “adherence”. Attention was focused on research papers that dealt with both physical and mental conditions. Priority was given to any evaluation of techniques potentially useful in improving concordance, and research papers frequently referred to by other authors, or otherwise indicated as seminal. The review was limited to studies carried out in the UK, Ireland, and the USA. It was of course, necessary to limit the final discussion to a representative number, which aim to reflect some changing views, with emphasis on recent research.

Gray, et al. (2002) note that non-compliance with antipsychotic medication is a major preventable cause of relapse in psychotic patients. The causes of non-compliance are seldom immediately clear, and the literature suggests a large number of factors interplay, and individual reasons for stopping medication can be arbitrary. Evidence-based medication management aimed at enhancing treatment concordance should include a collaborative, educational approach to working with patients, tailoring medication regimes to the patient. Gray, et al. advocate using therapeutic techniques such as compliance therapy, discussed in this review, in order to empower individuals, and preserve their right to choice.

Compliance or concordance?

Repper and Perkins (1998) highlighted the importance of terminology in mental health, and suggest that the use of words like compliance infer patients should be passive recipients of health-care, and should obey professionals. It has recently been proposed that “concordance” should replace the words “compliance” and “adherence”.

Concordance emphasizes patient rights, and the importance of two-way decision making. More controversially, it also suggests patients have the right to make choices such as stopping medication, even if...
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