Mental health articles

The use and understanding of the language in this area has significant meaning and impact for professional practice. The literature reveals a development in terminology reflected in a shift in the balance of power of the relationship/alliance of the prescriber and health care workers with the client. Overall, this describes a change in value, from the client as a passive recipient of health care to an informed partner in health care decision making.

The following descriptions from the literature illustrate this development. Dodds et al. define compliance as the extent to which a client’s behaviour regarding taking medication coincides with medical or health advice. Marland and Sharkey discuss the value-laden term ‘compliance’ and that interpretation varies with each individual professional. They also propose two further dimensions to the concept. The first as being process defined, influenced by the degree of conformity to the prescription. The second as being outcome defined, being determined by the maintenance of wellness. Interestingly, this latter dimension implies that wellness may not correspond with compliance. The language of compliance then undertakes a further shift, to the concept of effective, collaborative working with clients. These authors identify successful collaboration between professionals and the client as the most valuable approach in improving compliance, assuming that compliance is appropriate. The concept of collaboration has since shifted to one of concordance, suggesting that an equal partnership, in working harmoniously, needs to exist between health care workers and the client before clients will ‘buy’ in to the need to comply, if appropriate, with treatment. There is a clear relationship between compliance with prescribed medication and best practice in medication management.

However, it is imperative that compliance is not the main target. In fact non-compliance for someone suffering from severe adverse reactions might be life-saving in cases of inappropriate prescription. Hence, a crucial element of best practice in medication management-concordance is about health professionals, clients and carers recognizing that a problem may be medication related. Permeating into the literature and into current health policy is a further shift along the language continuum with the concept of choice. T

he power, the opportunity of clients to make informed choices about their health ‘… positive outcomes are increased if people are informed about their choices, allowed to choose and given their choice. That is the clearest finding based on the views of thousands of people with direct experience of mental illness’.

Tags: medication, medication management