Psychiatrists are encouraged to shift their approach to medication adherence by normalising lapses and tailoring interventions, including motivational interviewing, to address underlying barriers such as forgetfulness, doubts, or stigma in patients with serious mental illness.
Clinicians working with people who have serious mental illness can miss a common and damaging problem: patients quietly skipping prescribed medication. Psychiatrist Christoph Correll, writing in Psychiatric Times, argues that the most useful starting point is not a blunt compliance check, but a question that normalises imperfection and invites honesty. Rather than asking whether a patient has taken every dose, Correll recommends asking how many doses have been missed since the last appointment, a wording that assumes lapses can happen and makes it easier for patients to talk about them.
That shift matters because many patients will say they are taking their medicine even when they are not, often because they do not want to disappoint the clinician. Correll says missed doses may reflect several overlapping pressures: forgetfulness, cognitive difficulties, doubts about whether the treatment is helping, anxiety about side-effects, or disbelief that they have an illness at all. Once the subject feels safe to discuss, the next step is to identify the reason behind the non-adherence rather than treating it as a single problem.
The Psychiatric Times piece says the response should be tailored to the barrier. A missed dose caused by forgetfulness may be helped by a simple alarm or reminder system. But ambivalence, mistrust and stigma need a different approach. In this context, stigma refers to the feeling that treatment makes people seem more unwell than they want to appear. Correll points to motivational interviewing, a counselling style that is collaborative rather than confrontational, as a way to frame medication not just as illness treatment but as something that helps patients work towards their own goals.
That approach is backed by wider psychiatric literature, although the strength of evidence is mixed. A World Psychiatry review by Joseph Kane, Jun Kishimoto and Correll described non-adherence in psychotic disorders as common and shaped by a range of clinical and social factors. Other research, including studies indexed on PubMed and a chapter in Cambridge University Press, suggests motivational interviewing can improve adherence in some psychiatric settings by building internal motivation and self-efficacy. At the same time, a literature review on schizophrenia cautioned that it should not be treated as a stand-alone first-line solution, underlining the need for personalised care and ongoing research.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
