Non-compliance with medication as a common reason for admission to a closed psychiatric ward

Noncompliance with pharmacologic treatment is common amongst patients suffering from chronic diseases. In psychiatric patients compliance is extremely important in order to prevent recurrence of the disease. Recurrence is associated with readmissions and increased costs to the health system. About 70% of patients suffering from schizophrenia will relapse within a year without medication. This study evaluates the causes of admission and diagnoses of 100 patients consecutively admitted to a closed psychiatric ward between 1.4.2000 and 23.6.2000. Fifty four of these 100 admissions were associated with medication noncompliance in the last year. Noncompliance was not associated with psychiatric diagnosis, gender, type of medication or form of administration of the medication. The problem of noncompliance should be approached on two levels: the doctor-patient relationship and reorganization of mental health services. On the doctor-patient level, the therapist has to maintain a therapeutic alliance with the patient and his family and adjust the medication accordingly, in order to maximize the benefit and minimize side effects. On the health system level, mental health should be included in the National Health Insurance Law and the Health Funds should take responsibility for mental health as in other medical fields. This may enable the psychiatric patients to be under the care of their general practitioner in continuity with the psychiatric hospital. Thereby, resources should be transferred from the psychiatric hospitals to the community. The availability of the psychiatric community services and their links to the general healthcare system would increase compliance and reduce recurrence, readmissions and the stigma of patients suffering from psychiatric disorders.