“You kept telling me to speak with Elva about it. I just kept it to myself. And I just stopped taking my medication.” Henry articulated these words to Lily, with sadness in his voice. Lily, also sad, wishing she could have turned back the clock, replied, “I am sorry. I should have taken the time to listen to you, and, at least, try to understand what you wanted to tell me.”
Henry was alluding to his attempt to tell Lily about his medication. But, given her limited knowledge, she immediately redirected Henry to Elva the nurse. Today, Lily told Henry, “I should have taken the time to really listen to you and at least try to understand…”
Lily is a skilled clinician and a great listener, and she worked very hard to earn Henry’s trust. She was also aware that she knew nothing about psychotropic medications and dealt with that by avoiding any related conversations with her patients or clients.
As we strive toward less fragmented care for our patients or clients, basic knowledge of psychopharmacology is essential for non-medical staff.
Here are 5 reasons why:
“You kept telling me to speak with Elva about it … ” Henry articulated these words to Lily, during her visit to the psychiatric inpatient unit, at the HOPE Hospital. Lily, a social worker with the HOPE ACT team had been successfully working with Henry, earning his trust; and now he wanted to tell her about the status of his medication use. Henry had been experiencing an adverse side effect from his Risperidone, and he did not feel comfortable disclosing to his psychiatrist or his nurse. He was comfortable speaking with Lily about it. However, because she redirected him and failed to give him the attention he needed, Henry decided, instead, to simply stop taking his medication. As a result, he later decompensated and required inpatient hospitalization.
Many factors influence medication adherence and side effects are among the most influential ones. The therapeutic relationship also highly affects medication adherence. And, as mentioned in a previous article, Basic Integrated Care Skills for Non-Medical Staff: 5 Reasons Why, several non-medical staff typically spend more time with patients and clients, when compared to medical staff, and this often leads to a strong therapeutic alliance. Understanding this alliance can provide the leverage needed for all parties to help with medication adherence; and, a basic knowledge of psychopharmacology for non-medical staff can be very helpful in facilitating this process.
Minimized overwhelming feeling
Six months before her work with Henry, Lily had gone into the field to meet with Guy. Elva, the nurse, asked Lily to take Guy’s medication to him. At the time, Guy had lots of questions about his new medications, questions that his psychiatrist, Dawn and his nurse Elva, had already answered. But Guy’s memory was failing and he needed constant reminders. Lily panicked during that situation because she mostly felt overwhelmed and did not know how to respond to Guy. It was that sense of feeling overwhelmed that influenced her work with Henry, and it prevented her from listening and seeking to understand Henry, when he wanted to confide in her about his medication.
Non-medical staffs are not expected to master the fund of knowledge in psychopharmacology. However, some basic and fundamental understanding can help minimize that experience of feeling overwhelmed, allowing you to meet your patients or clients where they are.
I have always mentioned that knowledge empowers. It allows you to stay calm when under pressure (when your patient or client is escalating, for example). And it also helps you stay confident and still be decisive amidst uncertainty. I have also mentioned that knowledge helps prevent burn out and promotes career gratification, for it gives you a feeling that you are doing your best, while also seeing positive results in the lives of your patients or clients. Feeling empowered requires paring the need to be inquisitive with continuing learning.
Lily earned Henry’s trust, and he wanted to tell her about issues around his medication. After their conversation at the hospital, Lily decided she would do what was necessary to empower her understanding of psychopharmacology through acquiring and developing a basic foundation knowledge base. This would allow her to feel more at ease when listening to medication concerns of her patients and clients, without feeling overwhelmed. That would also empower her to at least know when to tell Henry, “I don’t know the answer to this, but I can find out for you.”
I have always recommended that clinicians feel at ease and strive to learn with their patients and clients, regardless of how much they know or don’t know about a specific topic. Sometimes this is easier said than done, but being able to tell your patients and clients, “I don’t know much about this. Please let me know what you know,” puts you at a position of strength instead of weakness. It also gives you an opportunity to model for your patient or client. A basic knowledge of psychopharmacology can help even more under these circumstances, and it can be an empowering tool.
Agency and System Perspective
Had Lily not felt overwhelmed, had she felt empowered, she would have been able to take her time to listen to Henry and report back to Elva, who then would have reported Henry’s complaint to his psychiatrist, Dawn.
Henry had just started to develop impotence (inability to have an erection) from his Risperidone. He felt very embarrassed to tell Dawn or Elva, but felt comfortable speaking with Lily about this. Lily should, indeed, always encourage Henry to speak with Elva and Dawn; however, this recommendation would come after properly listening to him.
As already mentioned, because of a lack of basic knowledge, this was a missed opportunity. Basic fund of knowledge in psychopharmacology will enhance communication among all team members and may help decrease several unfortunate outcomes, like the one described here.
Maintained stability and decreased waste:
Henry stopped his medication and started to feel paranoid. He woke up in the middle of the night, and accused his roommate of touching his “private parts.” He was found with a knife, waiting for the “right moment to get at his roommate, Jean.” Henry did not tell anyone he was experiencing medication side effects. However, he was willing to tell Lily, one of the team members, and that bit of information could have prevented his destabilization, an ER visit, and an inpatient hospitalization.
“You kept telling me to speak with Elva about it. I just kept it to myself. I just stopped taking my medication.” Henry said this to Lily, who confessed that she is now determined to take the proper steps to “do things differently, going forward.”
Basic knowledge in psychopharmacology for non-medical staff is in everyone’s best interest. It helps improve adherence, diminishes the likelihood of feeling overwhelmed, empowers decision making, enhances communication among staff, patients and clients, and it helps maintain clinical stability and decrease waste.
Lily promised to start learning the basics of psychopharmacology. What about you? How do you rate your knowledge of psychopharmacology? How empowered enough do you feel to help educate your patients and clients about medications; how much are you able to adequately communicate with your medical colleagues about the medications for your patients or clients?
Please share your experiences and thoughts, and, in the meanwhile, I hope you start thinking about all benefits of basic knowledge in psychopharmacology for non-medical staff, and share them with your colleagues.
Let us converse again soon.
Your friend and colleague,
With this series of 5 articles, you now have a foundational knowledge of antipsychotics.
Dr. Sidor is quadruple board certified in psychiatry, with vast clinical, teaching, supervision, mentorship, and management experience. He also has extensive experience in public speaking, leadership, business, and research, in addition to a passion for program development and project management. His overall goal is to empower all health care professionals throughout the United States and globally, towards ensuring the continuity of excellent patient care, while balancing the need to take care of themselves. Dr. Sidor is the main instructor for the SWEET Institute, and he is currently an Assistant Professor of Psychiatry at Columbia University. He is also the Medical Director and Chief Medical Officer for CASES (Center for Alternative Sentencing and employment Services), and he speaks and writes fluently in six (6) languages—French, English, Spanish, Portuguese, Creole and Italian.
Lambert M, Cones P, Eide P, Mass R, Karow A, Moritz S, et al. Impact of present and past antipsychotic side effects on attitude toward typical antipsychotic treatment and adherence. Eur Psychiatry. 2004;19:415–422.
Olfson M, Uttaro T, Carson WH, Tafesse E. Male sexual dysfunction and quality of life in schizophrenia. J Clin Psychiatry. 2005;66:331–338.
Vrijens B, De Geest S, Hughes DA, et al. A new taxonomy for describing and defining adherence to medications. Br J Clin Pharmacol. 2012;73(5):691–705.
Wroe AL. Intentional and unintentional nonadherence: a study of decision making. J Behav Med. 2002;25(4):355–372.
Linn AJ, van Weert JC, Smit EG, Schouten BC, Van Bodegraven A, Van Dijk L. Words that make pills easier to swallow: a communication typology to address practical and perceptual barriers to medication intake behavior. Patient Prefer Adherence. 2012;6:871–885.
van Dulmen S, van Bijnen E. What makes them (not) talk about proper medication use with their patients? An analysis of the determinants of GP communication using reflective practice. Int J Pers Cent Med. 2011;1:27–34.
van Dulmen S, Sluijs E, van Dijk L, de Ridder D, Heerdink R, Bensing J. Patient adherence to medical treatment: a review of reviews. BMC Health Serv Res. 2007;7:55.
Roebuck MC, Liberman JN, Gemmill-Toyama M, Brennan TA. Medication adherence leads to lower health care use and costs despite increased drug spending. Health Aff (Millwood) 2011;30(1):91–99.
Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2008;2:CD000011