Enhancing Adherence to Treatment for Clients with Serious Mental Illness

Non-adherence to treatment is a common problem in many chronic disorders with higher rates among

clients with mental disorders. Non-adherence to treatment greatly compromises the

effectiveness of psychiatric treatment and is associated with higher rates of relapse,

hospitalization, and increased health care costs. Hildegard Peplau’s theory of the nurse-client

relationship and Ludwig von Bertalanffy’s general system theory provide a model for

intervening to increase adherence. The study was conducted over a 90 day period in the outpatient service of a for-profit psychiatric hospital. The intervention involved

communication between office visits by an advanced practice nurse who contacted clients via phone or email.

Thirteen adult clients between the ages of 21 and 59 agreed to participate (four males and seven

females). Patients’ diagnoses included bipolar disorder, major depressive disorder, anxiety

disorder, and post traumatic stress disorder. All of the participants were new to the clinic and

had a history of inconsistent compliance with medications. Clients were asked to keep a daily

log of psychotropic medications taken. They were considered as meeting the goal of adherence

when taking the medication 75% of the time. Their attendance to psychiatric appointments was

also recorded. Chi-Square tests indicated that APRN communication was significantly associated

with consistent adherence to medications (χ2 (1, N = 13) = 13.00, p < .001) and to psychiatric

appointments (χ2 (1, N = 13) = 13.00, p < .001). These results support the use of an evidence

based intervention to enhance adherence to psychiatric treatment. Recommendations for further

study include recruiting the psychiatric providers to provide the intervention and conducting a

cost effectiveness analysis.