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APHA Scientific Session and Event Listing

Irma H. Mahone, RN, PhD, School of Nursing, University of VIrginia, P.O. Box 800782, Charlottesville, VA 22908, 4342951463, ih3xn@virginia.edu

Abstract Psychotropic medication remains the single most effective treatment for reducing the active symptoms of psychosis, yet medication adherence rates for persons with serious mental illness (SMI) remain at about 50%. In non-psychiatric chronic illnesses shared decision making (SDM) between client and healthcare provider has proven successful in improving adherence rates and improving effectiveness of treatments. Self-care and health-promotion concepts are central to the concept of SDM and medication self-management in the SMI population. With the idea of recovery in mental health came the focus on quality of life, empowerment of persons with SMI, and participation by the clients, which is similar to trends in non-psychiatric illnesses. Because of cognitive limitations such as thought disorganization, physical and mental slowing, memory difficulties and debilitating psychosocial deficits, decisional capacity may be another variable that influences both the preference for and actual involvement in the client-professional interaction, and also affects the outcomes of medication adherence and quality of life. Also perceived coercion has been identified as a significant variable in the therapeutic alliance, medication and treatment adherence and on long-term outcomes for persons with SMI. This cross-sectional, correlational study interviewed eighty-five persons with SMI during a routine clinic visit at the Community Mental Health Center. This study evaluated the strength of the relationships between the constructs of 1) perceived coercion, 2) decisional capacity, 3) preferences and actual participation, 4) medication adherence attitudes and behaviors and 5) quality of life as they relate to medication decision making in persons with SMI.

Learning Objectives: