To think the mentally ill have a personal responsibility to take their medication?

[ABD091G6]

For the umpteenth time a close relative has stopped taking their medication, a choice they made whilst medicated and stable, and now we're all dealing with the fallout from that and treading on egg shells waiting for the malicious phone calls and harassment to start

If somebody relies on antipsychotics and mood stabilizers to be stable and able to function, they have a personal responsibility to remain medicated.

AIBU to think that they are expected to take responsibility for themselves.

I haven't always been so intolerant, my (probably quite mean really) view is the result of many years of highly stressful situations imposed upon me and my DM when in all honesty neither of us are equip to handle them.

I'm no stranger to mental ill health, I have PTSD, OCD (the pure O form) and GAD as a result of trauma. I also had PND after the birth of both my children. Even at my rock bottom I knew I had a responsibly to my children and myself to get well and made every effort to get better. I had talking therapies which helped alot and I'm on beta blockers for the GAD.

I make a conscious effort to look after myself and practice self care, avoid my known triggers and make an ongoing commitment to do all I can to remain stable.

I'm not saying it's that easy for everybody and I'm certainly not implying I'm better than anybody else, I'm mentioning my own MH only to explain that I do understand to a degree

My relatives case is quite different as they are schizoaffective, but I still have a current belief that they should be doing what they can, to the best of their individual ability, to stay as well as possible.

Try being a bit kinder.

This is really unfair. It sounds like OP and the family were kind. I can't believe that a reply to someone being harrased and abused repeatedly even if the abuser is ill should be "try to be kinder"...

Bipolar meds (antipsychotics and mood stabilizers) knock about 20 years off your life. When people mention "the side effects" they truly are horrific, like, if you had those as symptoms of an illness the doctors would be bending over backwards to help but since it's viewed as less bad than being stable, you're basically left to it.

Additionally, with most psychotic illnesses these days, even the medical practitioners no longer advocate medication for life. The goal now is to get stable then taper off them because of the length of time between episodes for most people.

I understand where you're coming from, having a relative who wouldn't co-operate or take their meds. But as someone who has taken these, I can honestly say if you haven't taken them, you can't know what it feels like that you one day wake up and think "actually, the suffering and mental turmoil was BETTER than these side effects".

Unfortunately one of the defining characteristics of mental illness is profound loss of insight and inability to be responsible (hence they can be sectioned for their own safety at times). We don't medicate people with such heavy shit for nothing.

I can understand where you're coming from.

My dad is on end of life care atm and my is, without a doubt, suffering from depression, not entirely caused by the situation with my dad.

There is only me to support/care from the both and I find it a million times harder to contend with mum's emotional issues than I do with my dad's personal care. Mum absolutely refuses to engage with the idea of getting MH support, much less taking ADs.

That said, as someone who suffers anxiety and depression (exacerbated by underactive thyroid), I know how very easy it is to get into a lack of self care - don't take meds - greater depression - self care gets even harder etc etc spiral.

I have been kind.

I've tried never to take personally the things they say when they're off their medication.

I haven't responded with anger/irritation when they've turned up at my door late at night, or when I've had to take my then-newborn out for a walk at night because they've told me they're on their way to my house whilst unwell and I'm scared.

I've taken supplies to them and visited when they're regularly sectioned.

I've sent cards and presents so they know I'm thinking of them.

I've tried to reassure my DM that it's not their fault when they've gone off on one and demonized her for any perceived slight.

I've gone to their flat to feed their cats and rectify all the damage they caused in there prior to being sectioned for the 5th time in a couple of years.

I've stayed on the phone throughout their delusional rants just so they don't feel totally alone or abandoned.

I'm not totally devoid of empathy I'm just worn out because it's constant.

Oh and one other issue is that if you don't get your repeat Rx quickly enough, GPs won't give it you without an in-person appointment. I used to get told to go back to the GP every 28 days or I wouldn't get my medication. So at that point, when you can't even get a GP appointment, or can't get time off work to go, and they won't give you the medication you need, you can end up really stuck and lacking in insight to know how to solve the problem.

Your relative is ill. They need support and understanding.
YANBU to wish that life pottered along in the way it does when the illness is under control, but YABU to expect that to happen without care and ongoing support.
It sounds like the point may have come where additional support may be required as it is getting too much for your Mother alone.

People do this all the time, with all sorts of medications and other sorts of treatments. How many people go on diet and fitness kicks to become more healthy, then reach their goal and think they've 'done it', so relapse into their former unhealthy ways? You could just as well berate them for whatever impacts their unhealthiness has on others.

A lot of people perceive psychoactive drugs as suppressing their personality, making them less themselves.

I think you might be overestimating the person's awareness of how ill they become and how great an effect this has on others. I don't think people always view themselves as having been irrational. They still hold the same beliefs they did when unwell, just suppressed, or not seeming relevant at the present moment. Dig deeper and they'll still tell you that the thing that, to you, was plainly an irrational belief, was true.

All you can do is tell them how it is for you and what action you will or will not be taking as a result.

But is is totally fine for you to feel angry. And to tell them 'no'.

They do receive alot of support. They have a CPN and community MH support workers, two of which visit regularly to monitor med compliance.

They come several mornings a week to check in, have a chat and watch my relative take their morning dose of meds.

The afternoon dose is, unfortunately but understandably, entrusted to them to take themself.

Relative gets around this by taking the morning meds then throwing away the afternoon ones. After a period of time the inconsistent medicating starts to trigger a relapse and my relative then stops complying full stop.

MH services are unable to intervene until relative gets to crisis point and then will be sectioned again.

They'll comply with meds when in hospital then repeat the cycle when they go home.

My relative has actually said on multiple occasions that they want to go into hospital "for a break and to save money" so I do believe, to a degree, that the non compliance is deliberate sometimes and they have a goal in mind.

There has also been several occasions where med non compliance has coincided with somebody else in the family having a hard time/having a baby/getting married/needs support in one way or another.

My DM has said herself (regrettably) that sometimes she believes our relative uses their poor MH and decision to be noncompliant to manipulate situations and have people rush to their beck and call.

You're under no obligation, moral or otherwise, to offer so much support to someone who's mentally unwell that you compromise your own mental health. This is really important - you need to prioritise your own health and if that means taking a step back it is ok to do that, guilt free.

I don't want to join in a pile on but I do want to say that "medicated and stable" is not the same as "well" - stopping medication is not as straightforward as a mentally well person making a selfish decision to become mentally unwell. Sometimes the medication is wrong, or it was right before but something has changed and it stopped working. Sometimes the medication makes it easier for a person to hold it together most of the time but if they go through a bad patch it might not be enough.

I don't know how much contact you have with their support professionals but if you get a chance, can you ask them about long-acting medications (e.g. you can get long-acting injections of the typical antipsychotic Haloperidol that last 3 months)? I'm surprised any region has the MH resources to give someone daily visits for medication compliance unless that's their only option, so I'm sure they've already considered injections but just in case they haven't, it might help.

I know you said in your OP that your relative is very compliant (and I was responding initially based on why someone with good insight would go off their meds) but honestly from your updates it doesn't sound like they've internalized that they really have a problem, or ever truly gained insight in anything other than "if I make the right noises they'll discharge me from hospital".

@toolazytothinkofausername

Also too lazy to think of any valuable input to the discussion. Or too thick.

OP I do empathise with you. It's compassion fatigue - you've just dealt with too much stress as a result of this situation that you're losing the ability to empathise anymore. That isn't your fault. The thing is though - and I can't comment on how the person you're talking about as I don't know them or their capacity to understand the impact of stopping their medication - but some people with certain mental illnesses will be stable on their medication therefore think they don't need it and so stop. They then become unwell and it takes a long time to get them re-established onto their meds and time for them to stabilise. Then they can be stable for a while but then fall back into thinking the don't need their medication again.. and so the cycle continues.

I take it you've had a frank discussion with your relative? It's perhaps time for an MDT meeting with the CPN/psychiatrist to see if a more robust package of care can be put in place.

You are being massively unreasonable.

Dealing with a person who experiences psychosis, psychotic episodes, or any other mental health problem is absolutely frustrating, worrying, and frightening at times. You are not unreasonable to think something to yourself along the lines of 'FFS, why can't you just take your medication, which clearly makes you better than you are now' - that's the frustation.

You are extremely unreasonable however to genuinely not realise the clue is in the name, mental illness. Meaning their mind is not functioning well. With episodes of psychosis, the very definition is losing touch with reality - and in this, not taking medication is an extremely common sign of such.

A person with an unmanaged health condition (and it is unmanaged, if they want to stop taking medication altogether for a severe mental health issue) is often not capable of making sound decisions that a person with a 'sound mind' is, and it's unreasonable to hold them to the same bar of mentally well people, as I say the clue is in the name really, mental health illness.

People can also go through swings of understanding they are unwell, and particularly with psychotic episodes, suddenly thinking that they are not unwell at all. Often accompanying this, is delusions and paranoia, very often including medication and feeling of people 'plotting against them'.

No medication is a cure. It relieves some of the symptoms and does improve matters, but that person still has a mental health illness which is prone to relapses, and relapses are extremely common. Very often people get used to a medication, and over time it reduces it effectiveness. This is another common symptom, when relapses occur (even small ones) when taking a dose of medication that previously helped them manage quite well. Often then the medication needs upped, or changed.

I agree that it is incredibly frustrating and upsetting. I agree that the impact of this on those closest to the sufferer is horrendous, stressful and often too much to bear. I also believe that often people suffering this type of thing need intervention, rather than relying on family and friends who will quickly succumb to the stress. There needs to be more support.

If the person has been on the books for years and has a CPN, then they are pretty fucking poorly OP. Families need far more support. However, you need to educate yourself and have a better understanding. I understand where your thoughts come from though, it is so upsetting.

In case it helps, here's a list of which ones are currently available in long-acting injections (the article says they're for schizophrenia but they're used for other psychotic diagnoses as well such as schizoaffective disorder and bipolar disorder): www.webmd.com/schizophrenia/schizophrenia-long-lasting-drugs#1

My DH is in same position. On antipsychotics. Intelligent. Decides to stop and becomes aggressive, impatient and paranoid
However, he’s tried 3 types of antipsychotics over 15 years. They all have significant side affects.

At worse these are massive weight gain and type 2 diabetes. At the most benign they cause him to be sleepy, hard to find motivation, confused thinking. It’s like switching off half his brain- yes it stops the psychosis but stops a lot of other things.
I can understand why he does not want to take medication- his quality life is dismissed because of it. I agree with him that it is shit. But without them we’d have to split up ( married 30 years). He’s just into another new regime after stopping for 12 months. We actually got as far as planning a divorce so he could live alone without meds. In the end he “gave in” to save the marriage. He hates what the new drugs have done to him in just 8 weeks- and I don’t disagree.
All drugs have side affects. All Antipsychotics are particularly bad. You can do the changing regime bit, and reducing doses to minimum to hat the hallucinations, but it still reduces that persons ability in day to day life. That impacts terribly on self esteem and poor mood and that doesn’t help.
I know I am going to encounter DH coming off drugs again some time before one of us dies. We may still end up divorcing. But honestly, I can see why he wants to stop.

Yes I would say we have a responsibility but sometimes it’s not that clear cut. I have stopped taking medication before. 1st time was because I thought I was ok and didn’t need them anymore. The last time I was sick of having to live around my medication schedule and restrictions.
You can’t understand why any individual stops until you ask them.

This is so hard, one of the people I love most in the world has a diagnosis of schizofrenia.

They have done so incredibly well and have only had minor relapses for the past 15 years, and lead a fulfilling, successful, fully independent life.

but, the meds side effects are just awful, I have seen them put on a lot of weight. At times, saw their intelligence dimmed, their attention suffer, often their spark gone. Not always, sometimes they are just fine and their old self, sometimes they are not

it is still better than the really scary psychotic episodes, of course, but it is very, very hard!

By the way, manipulation is also a very common sign of SOME mental illnesses. Again, they are not well, and the more you write about the person the more blatantly obvious it becomes.

As is deceptive behaviour (taking the medications in the presence of mental health teams) but not taking them later. This is very common.

I am sorry you do not have more support, and speaking from experience there needs to be far more than there is. It breaks those closest to the people. It is easy to experience dislike towards the ill person, because of the unpleasant characteristics that often present themselves. But, I do strongly believe you need a change in attitude OP, because it's helping no one. Whoever is in charge of the mental health care for this person (probably a psychiatrist) needs to be informed of this refusal to take medication. You may have already done that, but keep pushing, if you can. Please realise this person is unwell, and not by choice and are not choosing to be this unwell, however much it does seem it at times with the manipulation etc. This is just not the behaviour of a well person.

I will also comment...read symptoms of schizophrenia and other psychotic illnesses. There is a specific symptoms which causes the patient to be incapable of understanding they are ill. It’s not they don’t want to be told. It might help to read up on how the brain works during psychotic episodes and that, for instance, hearing voices, is not listening to something that is not there. In MRI scans the external auditory receptors light up in same way as they do when hearing an external voice. The internalised voices are short circuiting in effect and triggering additional wrong parts of brain. There is simply no perception that something is “wrong” or a difference between hearing voices and someone actually talking. Hence bizarre behaviour where patient is looking for the source of the voices through a TV etc- they’re actually frightened and confused in the same way as you would be if the tv started talking to you when off.
It’s not like cancer where you know you are ill due to pain, weight lose, and other physical symptoms. Or even a headache when you know your head is sore. There is simply no perception that they are ill as their phsychotic perceptions are being received and processed in the same way as normal stimuli.

If the personal responsibility fails, would the next step be compulsory administration of medication by the State?

I don't know.

What does annoy me is a mentally ill person killing another person, sometimes a total stranger, and getting away with it.

Having anxiety ,Depression, PTSD etc is very different to having a psychotic illness ,people who are psychotic very often lose touch with reality ,they may be hearing voices ,having ideas of reference ,telling them not to take medication

Is it possible to get into contact with the community mental health team, just so they're aware? Potentially with a view to discussing receiving the depot injections if that's an option.

MH medication often has horrible side effects. Yabu

@x2boys

Having anxiety ,Depression, PTSD etc is very different to having a psychotic illness ,people who are psychotic very often lose touch with reality ,they may be hearing voices ,having ideas of reference ,telling them not to take medication

I appreciate that, I know they're very different illnesse.

I only mentioned my own MH to put across the point that I'm not totally ignorant with regards to mental ill health nor do I have disdain to people with poor mental health in general.

I can't relate to somebody with schizophrenia/schizoaffective disorder, granted.

I have approached their psychiatrist/MH team so many times I feel they're probably tired of hearing from me. I'm not telling them anything they don't already know and their hands are tied until my relative declines to the extent that being sectioned is the only option.