Working with partners, families or carers
Taking (and withdrawing from) psychiatric drugs can have significant implications for partners, family, carers and other people involved with the client. For example, in the case of some older adults, or those with learning disabilities or communication difficulties, carers, partners and families are likely to be involved in supporting the client. It is important to consider, from the perspective of your own setting and preferred therapeutic framework, the range of issues associated with contacting and working with carers and/or family members (see the full guidance, Note 1, 3.3).
Working with the client’s prescriber
If you are concerned about a client taking or withdrawing from psychiatric drugs, you may also wish to consider contacting the client’s prescriber. This decision will depend on many complex and overlapping factors: whether contact is at the request of and in the best interests of the client; whether the client has given consent; your preferred therapeutic model and rationale for communicating – or not – with the prescriber concerned; your work context; and your previous experience of initiating contact with prescribers and other medical professionals. Where contact is made, it is important not to undermine your client’s relationship with their prescriber. However, you may need to be prepared respectfully to support your client’s right to make informed choices.
You may also wish to bear in mind the extensive debates in the field about the overprescribing of psychiatric drugs in marginalised groups, including those from black and ethnic minority backgrounds3. It is also important to be aware of the implications of adverse drug effects for particular groups of clients such as those who are either planning a pregnancy or are pregnant, and older adults with diminished physical capacities who may be more prone to falls.
The impact of legal frameworks
There are complex issues to be considered when working with clients who are required to take drugs because they are detained under the Mental Health Act or being treated under a Community Treatment Order (CTO). In these circumstances, you will need to be alert to the way in which pharmacological treatments are likely to impact on the therapeutic relationship, working with clients to support them within the limitations imposed by the relevant legal frameworks. Difficulties are also likely to arise where clients rely on prescription psychiatric drugs to demonstrate eligibility for benefits such as Employment and Support Allowance (ESA). In these situations, you will need to explore sensitively and with care the extent to which anxiety about any possible loss of benefits underpins your client’s understanding of the causes of their emotional distress and drives any decision about withdrawing from prescribed psychiatric drugs. These are complex scenarios, and you will need to remain respectful of your client’s perspective and to value the choices they are able to make at all times.