What are the Therapeutic Strategies used by Mental Health Providers to Create a Therapeutic Alliance and Effective Patient- Provider Relationship for Psychotropic Medication Adherence?
Abstract
**Please note that the full text is embargoed** ABSTRACT: The annual cost of medication non - adherence problems in United States (U.S.) is
approximately $100 billion dollars (Heesch, 2013; Julius, Novitsky, & Dublin, 2009).
Mental health providers often encounter psychotropic medication non adherence among
incarcerated persons with schizophrenia despite their alliance- enhancing efforts, resulting in
increased violence, hospitalization, and an impact on economy. Therapeutic alliance, an effective
and collaborative relationship between the health care provider and the patient has a positive
association with treatment adherence as supported by the result of many studies (Julius et al.,
2009; Kvrgic, Cavelli, Beck, Rusch, & Vaulth, 2013 ; McCabe et al., 2012). The significance of
the therapeutic alliance between mental health providers and their patients led to the key research
question: What are the therapeutic strategies used by mental health providers to create a
therapeutic alliance and effective patient- provider relationship with the incarcerated persons
with schizophrenia? The pilot study was conducted using a descriptive non comparative design,
to survey effective strategies for therapeutic alliance perceived by mental health care providers
who work in Jester IV Correctional inpatient mental health facility in Richmond Texas through a
self- administered questionnaire Results: The strategic items that received the highest score of
"strongly agree" scale includes: team work (81.82%), acknowledging individuals' insight
(72.73%), empathy (72.73%) patient education on illness and medication side effects 63 . 64%,,
non-judgmental attitude towards delusion and hallucinations 63.64%, overall importance of
strategies 63.64%, and provider factors 60%.Conclusion: Mental health providers identified
therapeutic strategies for effective patient- provider relationship to encourage psychotropic
medication adherence. Schizophrenia "is a severe mental illness characterized by delusions and hallucinations"
(McIntosh, Conlon, Lawrie, & Stanfield, 2009, p. 1). Antipsychotic medications have shown
efficacy in the treatment of the positive, negative, and cognitive symptoms (Gray, White, Schulz,
& Abderhalden, 2010). Patients with schizophrenia have the highest rate of anti psychotic nonadherence;
they are the most frequently committed to institutions because of violent behavior
resulting from antipsychotic medication non adherence (Acosta et al., 2012; Canas et al., 2013;
Shelton, Ehret, Wakai, Kapetanovic, & Moran, 2010). Failure to take effective medication as
prescribed can be non- compliance when the provider has the role of providing solution to the
patient's health belief barriers to compliance, or non-adherence when the patient's role is the
most important determinant (McIntosh et al., 2009). Antipsychotic medication non-adherence
affects the economy, resulting in increased relapse rates, and increased hospitalization (Hansen,
Maciejewski, Yu-Isenberg, & Farley, 2012; Heesch, 2013 ; Julius, Novitsky, & Dublin, 2009).
Therapeutic alliance is an affective and collaborative relationship between patient and
provider (K vrgic, Cavelli, Beck, Rusch, & Vaulth, 2013 ). The quality of therapeutic alliance is
one of the major factors identified to affect medication adherence (Julius et al., 2009; Sylvia et
al., 2013). Poor therapeutic alliance has been identified as an impmiant factor affecting
medication adherence; providers can directly influence the quality of therapeutic alliance (Sylvia
et al., 2013). Developing a strong therapeutic relationship for patients with schizophrenia may be
challenging for mental health providers because of poor insight and delusions associated with the
illness. For the inmates with schizophrenia prison culture adds to the difficulty (K vrgic et al.,
2013). Strategies for development of effective therapeutic alliance are evaluated in this project.
The significance of the quality of therapeutic alliance in antipsychotic medication
adherence for inmates with schizophrenia, the effect of anti psychotic nonadherence on the
economy and safety of the public led to this project to identify the therapeutic strategies used by
mental health providers for effective therapeutic alliance.