Why Do People Not Stick with Treatment?

One of the biggest problems with mental health care is that many patients don't stick with treatment. They fly off their meds altogether or take them intermittently. Neither approach is good. As much as I bitch about meds like Seroquel, it's up to patients to find something that works even if it only works for a time. It beats the hell out of winding up dead or in a psych unit.

I've had docs estimate that on the order of 50 percent of their patients with bipolar disorder, for example, don't stick with treatment. I understand why they don't--many meds make them feel like shit, wreak havoc on their bodies (which in turn makes them social outcasts in an America obsessed with skininess) or the meds just don't work at all. Here's a report that states that treatment noncompliance--a term I hate--runs from 35 percent to 42 percent in clinical studies, which is to say in the best possible, controlled academic environment. In the real clinical world, it's worse. And, again, that is because meds sure can suck.

This study, however, is authored by an official at the NIH's National Institute on Drug Abuse. As you might expect, the author makes the case that booze and drugs are to blame for noncompliance. Of course, his job and continued funding requires that he say so. While I have no problem with him saying so, I am a little tired of docs blaming patients. It's a natural by-product of meds that work about 50 percent of the time that patients are going to drink and smoke weed and so on. It's also the result of a society where socializing amongst the normies is going to involve partying. The trick is in keeping it from getting out of hand. Moderation, people, moderation.

I am also tired of these reports that skirt the real issue: meds don't work well, and for patients it is a tough slog to find something that does work for them. Even where meds do work, symptom remission is rarely complete. That's just as important to our system of mental health care as people drinking or taking bong hits.

One of these days, we will hear consistent acknowledgement of this problem from the alleged "thought leaders" in the mental health field. We'll get studies and reports that have actual compassion for patients' situations instead of always blaming patients for doing something that the tee-totalling docs don't like. When that happens, docs can then go after booze and the like all they want. But, I predict, we will never get that kind of honesty from them because, at core, medical science is about controlling external factors and not about understanding the dynamic of peoples' minds and souls. We let that mindset control mental health care at patients' peril. As things stand now, their mindset and treatment paradigm isn't working well enough for the majority of patients.