To feel psychiatrist should limit medication of people at risk

[Mustbetheresson]

Friend has been honest about misusing her medication very hard for her as she finds it hard enough. The psychiatrist has said he will not issue her with weekly Scripts to help support her through this. He also added that patients need to take responsibility for their own safety and him limiting the amount of medication she can get at one time is him being responsible and not her. AIBU to think it’s part of hhis job to keep her safe? I understand patients untimely have responsibility for their own health but these no harm in helping them surely?

@Mustbetheresson

Friend has been honest about misusing her medication very hard for her as she finds it hard enough. The psychiatrist has said he will not issue her with weekly Scripts to help support her through this. He also added that patients need to take responsibility for their own safety and him limiting the amount of medication she can get at one time is him being responsible and not her. AIBU to think it’s part of hhis job to keep her safe? I understand patients untimely have responsibility for their own health but these no harm in helping them surely?

Untimely it makes no difference she could just save up the meds.

In extreme cases they supervise meds at house visits but rare and very short term

I thought that likely, it’s really key to recovery that patients with bpd are able to take responsibility for their own mental health where possible and are not overly reliant on other people.

She could ask the pharmacist to make up 4 one-week dosette packs and she collects one each week. However the psychiatrist will have balanced out the risk of her having a month’s worth of tablets versus the risk of her being unable or unwilling to make the trip on a weekly basis and not getting her medication at all. That could be just as risky.

But surely these an element of negligence in his actions?

If it didn’t reduce the risk though surely they wouldn’t do weekly proscriptions for anyone as there would be no point.

I seriously doubt this is negligence. Its is much more likely to be part of a well considerd care plan. Lots of people want services to take responsibility for thier own behaviours and choices. People have to take responsibility for themselves as much as possible. It builds resilience in the long term, reduces reliance on services. It might seem harsh but it's effective.

@Mustbetheresson a lot of these replies are confusing. So your friend would like a weekly script to help her to manage her meds appropriately and her psychiatrist has said no? That does sound quite strange. Does she have a keyworker she could discuss with?

I do understand that he it could physically damage her is he not worried about that?

Yes she’s asked for weekly but he wants her to have monthly.

@Nackajory I would argue that her admission that she misuses her medication and request for weekly scripts to help with same demonstrates better resilience than being told she has to continue to struggle on. If one of our SU's came with this reasoning, we would commend their honesty and work with them to support medication compliance, not dismiss their concerns like this.

It’s more that she has been taking more than she should as a form of harming herself:

It's an arrogant and huge mistake for a MH professional to ignore this request for help from a client. There are some really awful psychiatrists out there.

@Mustbetheresson if no keyworker, then discuss with GP their reasoning who could advocate on their behalf. We're all for positive risk taking where appropriate, but in this scenario, it doesn't make a lot of sense to me why the psych has been so dismissive.

She has a nurse who agrees with him unfortunately:

She just says self harm.

@Mustbetheresson

It’s more that she has been taking more than she should as a form of harming herself:

Again, bizarre if the psych genuinely made that call. If she continued to struggle even with weekly, they would usually then look at daily dispense or depot injection where possible.

@Mustbetheresson

She has a nurse who agrees with him unfortunately:

I take it the nurse is her CPN (keyworker).

In which case, CPN will be actively working with her on this issue.

If not? More questions really need to be asked about why someone who is struggling with the misuse of prescribed medication is being dismissed as not needing any sort of additional support - it doesn't add up.

I’d also think about how open she’s being with her psychiatrist - you don’t know what she’s told him, she may have down played things or be telling you she asked him when she hasn’t. Which neatly places responsibility to him if she harms herself, it’s not at all uncommon for people to be less than honest about what they’ve told their doctor.

There are options for her to manage her own medication if it’s a concern for her, and weekly dispensing is easy to get around if you’re so minded.

In saying that, weekly dispensing/prescribing is more expensive, so the psychiatrist may have that in mind too - which isn’t good care but cost is always part of the equation. He’s not necessarily being negligent, he may honestly see no need and be encouraging her to manage her self harm/self medication as part of her treatment plan, eg supporting self efficacy, autonomy and impulse control all of which are an issue in BPD.