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?

Don’t much attention to the fact she’s requested it early. So just give her another month before it’s actually due.

Sometimes its due to logistics also. Weekly scripts in my experience often go wrong, and dont always leave much leeway for correction ( eg if you are picking up on day 5 of your script then theres only 24 hours to sort), also you get your prescription charge everytime you pick up.

Thus if theres family who are able to managenit as suggested in the initial post then its often preferable.

@DarkMintChocolate

It's very hard to overdose on some psychiatric medication and very easy to on others. I'm sure he's risk assessed your friend.

DD, who has BPD, would just take every tablet she had - which included paracetamol. However, she was on weekly prescriptions! Her DBT counsellor said she was the most severe case of BPD on his caseload.

I was diagnosed with BPD many years ago and would do the same.

As others have said she can get weekly ones directly from the pharmacist, just would she go every week to collect?

You could also ask her if she wants you to chaperone her to all her appointment.

Follow up 6 months down the line is the norm unless of course there are any changes.

I wouldn't put yourself in a situation of holding her meds. There is a chance that she will come banging on your door demanding her meds back and if she knows her rights, legally you cannot withhold them.

I had a dosset box of weekly supply of meds. I probably.won't die if I took them all but a month's supply or more is a different story. When they stopped doing Dosset boxes a few months ago I made sure with chemist that they would still give me not more than a week's supply because One out think I could trust myself with that amount. Although I would still be likely to use anything I could pay my hands on if I were that determined....

Why doesn’t she take a weeks supply and ask you to keep the rest and dispense when needed. The NHS isn’t an endless pit of money and resources need to be carefully managed.

She does need to help herself - I agree.

Maybe get her to discuss it with her local pharmacy. As another professional the GP/psychiatrist may take the pharmacist's opinion with more weight.

@DarkMintChocolate

It's very hard to overdose on some psychiatric medication and very easy to on others. I'm sure he's risk assessed your friend.

DD, who has BPD, would just take every tablet she had - which included paracetamol. However, she was on weekly prescriptions! Her DBT counsellor said she was the most severe case of BPD on his caseload.

@DarkMintChocolate for you and your DD. It is so hard isn't it?

Has your daughter been offered Dialectical Behavioural Therapy? It was a game changer for me and my symptoms have much reduced

The default assumption of so many posters that the SU must be a liar or irresponsible and that the HCPs could not possibly have done anything wrong is ever so revealing.

Usually the case with MH isn't it, and a reason things are rarely taken seriously and mistakes and poor treatment are accepted, because the SU must be mistaken, they're ill and don't know what is going on, or they don't know themselves better than a person they have an hour or so (if they're lucky) with a week. Eurgh.

Weekly scripts are common here for such medications, always ready for the same day every week, offered in a dosset box if multiple meds, and takes into account the plethora of different stressors and struggles etc people who need them are likely to face and attempt to mitigate them to make worrying about meds one less thing.

What medication does she take?

If she had only a weeks supply, what would stop her taking too many? There's still seven times her daily dosage there.

I can see where the psychiatrist is coming from, weekly prescribing doesn't solve the issue, not least because if she really wanted to do harm it's very easy to get other meds that don't need a prescription. What outcome is she looking for, is it really to reduce self harming behaviours, or is it more contact/ dependence with the MH Team?

Could she ask the pharmacy to blister pack her meds? Then someone/you can give her meds weekly.

On one hand, I agree that psychiatrists, like all HCPs, can and do fuck up. Some even with careful consideration because these things are complicated, some with lack of consideration because they have they're go-to and ignore variables, some with malice.

On the other, I wouldn't automatically assume lack of it's fucking up, a lack of consideration, malice, or neglect. There are multiple reasons to choose monthly over weekly - especially right now - that others have already mentioned. It's difficult to balance remarks/threats of self harm done with medication with the fact someone needs medication.

With supporting your friend, I'd suggest she comes up with a system that feels comfortable with - whether that's asking the pharmacy to hold meds, you holding meds, - and trialing it for a time period, maybe 3 months. Part of the issue with BDP/EUPD and some variants of PTSD, as others said, is giving over autonomy and capacity to others so something she is actively involving in keeping running over a period of time could have benefits.

Has your daughter been offered Dialectical Behavioural Therapy?

Yes, she had individual and group for a year. She has been much better since.

I just think as doctor the psychiatrist should take some sort of responsibility.

@Mustbetheresson

I believe she puts the request in early.

Well then one inexpensive option for her psychiatrist or GP is to refuse to prescribe more until the current batch should reasonably have run out, instead of constantly repeating the prescription early every month, which I'm surprised they keep doing to be honest.

You have known your friend over 20 years and clearly want to support her. She is lucky to have a friend like you.
Noone on here can give a clear answer to your question as only limited information is available and most people will not be health care professionals and will have varied personal experiences of mental health services.

Some things to think about :

• Your friend has a psychiatrist and mental health nurse involved in her care and between them they will have a lot of professional experience and knowledge guiding their treatment plan. Sure, people get things wrong or misjudge a situation and risk assessment is not an exact science, but you are quick to jump to the use of the word "negligence" - based on what? That your friend & you don't agree with them, or something more? I don't know if they are negligent or not, the legal bar for that is high and we don't have enough information to say that but I don't think it is helpful to jump to negligence every time there is a difference of opinion.
• Your friend should discuss her concerns with her team & if she wants an advocate to help her do that and if she wants you to be that person, fine, but otherwise just be aware you likely don't know the full story but only pieces of it. I am not saying your friend is untruthful, again I don't know that. But she may well be giving you a version of the story that supports her opinion and is likely to encourage you to respond in a particular way.
• Taking control of her medication for her - is that a responsibility you want or need? It seems to go against the professional advice of her team who seem to want her to manage this herself. Other posters have suggested problems that could arise with this. If someone needs to be looking after her pills are you the right person to do that and is she manipulating you into a situation that could become uncomfortable for you and be too much responsibility? What if you go on holiday for 2 weeks, need to give her more than a week's supply of pills and she tells you she doesn't know if she feels safe?

I don't know the answer to all this. You have known your friend a long time and no doubt that knowledge is guiding your judgement and many of your concerns may be appropriate but it is often worth taking a step back and considering whether you are becoming unhealthily overinvolved and do not have good boundaries here - not saying that's the case, but it's worth thinking about.