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Prisoners’ Experiences of Antipsychotic Medication: Influences on Adherence

Mills, A., Lathlean, J., Gray, R., Bressington, D., Forrester, A., and van Veenhuyzen, W. Prisoners' Experiences of Antipsychotic Medication: Influences on Adherence. Journal of Forensic Psychiatry and Psychology 22(1):110-125, 2011.

By Diane LoulouHand with assorted pills, Staff Writer, RTI International, Rockville, MD

Prison routines and environment exerts a strong effect on medication adherence and satisfaction among mentally ill inmates. This study explores prisoners' experiences of antipsychotic medication and examines the complex decision-making processes behind medication adherence and non-adherence. It also includes analyses of the following:

  • The history of inmates' non-adherence in the prison and the community
  • Reasons for non-adherence and adherence  
  • Experiences of side effects
  • Understanding of  medication
  • Prison-related factors
  • Administration of medication
  • Relationships with healthcare professionals

The mixed-methods study was based on clinical measures and qualitative interviews of 44 prisoners with fieldwork in two medium security prisons for males and one prison for females in England and Wales. Participants were required to be over 18, in prison for at least a month, and prescribed antipsychotic medication to treat a psychiatric disorder for at least 4 weeks.

 Factors Affecting Adherence

The great majority of patients felt motivated to take their antipsychotic medicine because it helped them to feel better and reduced specific symptoms of their illness. They also reported that it alleviated anxiety and agitation, and prevented self-harming. Just over half of the respondents, however, reported previous non-adherence, usually in the community before entering prison, for the following reasons: 

  • Patients were preoccupied with co-morbid substance misuse.
  • Patients forgot to take their medicine or did not go to appointments.
  • Patients did not believe their medication was working, particularly if they experienced unpleasant side effects.
  • Patients felt better and didn't think they needed their medication anymore.

Participants had mixed opinions about side effects and their impact on adherence. Most reported experiencing some side effects, such as shakiness, feeling anxious, depressed, sluggish, sleepy, or unmotivated. Approximately one-fifth of interviewees reported that side effects had reduced their willingness to take their medication in the past, albeit only temporarily. Over a third stated that side effects had to be tolerated to benefit from the medication.

Research examining adherence to other forms of pharmacotherapy among prisoners suggests that specific factors in the prison may influence adherence. In a study examining adherence to HIV medicines, the most commonly cited reasons for missing a dose were:

  • Running out of medication
  • Being absent or asleep when medicine was dispensed
  • Forgetting
  • Nausea due to side effects

Medication cannot be forcibly administered to prisoners under the terms of the Mental Health Act 1983 in England and Wales. The study explored whether prisoners experienced coercion or pressure, either overt or implied, to take their medication. The vast majority of respondents said that they felt free to refuse to take their medication.

In general, relationships with mental health professionals were viewed positively by interviewees. This accords well with previous research showing that the quality of therapeutic relationships with healthcare professionals is a strong predictor in determining adherence.

An Emphasis on Benefits

The variables traditionally explored in studies of adherence, such as attitudes towards medication, relationship with clinicians, and experience of side effects, may not provide a complete picture of the factors that contribute to mediation adherence. This study indicates that personal circumstances, such as prior substance misuse, knowledge about the prescribed medication, and whether the inmate is permitted to self-administer medication, also play an important role. Most respondents believed that their medication was working and subsequently kept taking it. The study concludes that interventions to enhance medication adherence should focus on helping patients recognize the personal relevance and benefits of the medication they are taking.

 Dr. Alice Mills' email address:

Posted Fri, Mar 2 2012 12:29 PM by Tracey Vessels


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