Wednesday, April 16, 2008

Why won't they take their medication?

How many times have you heard social workers, doctors, and police officers bemoan the fact that people with mental illness just won't take their medication? Particularly after some tragic crime is committed by an individual with a history of mental illness, the litany begins. The experts explain the various reasons those people won't stay on their medicine: they start feeling better and think they don't need it any more, they don't like the side effects, they forget. But there's one reason the experts never mention...there are so many obstacles thrown in the way of even getting the medication that many poorly functioning folks probably give up.

Ever since Gabriel got out of the state hospital a year ago, getting his medication has been a source of constant frustration for me. Because the medication he's on has a high risk of very serious side effects involving liver function, initially he had to go for blood work every week. Now he goes every 2 weeks. The scrip has to be presented in person and the blood work has to be faxed to the pharmacy before it can be filled. The medication is so carefully controlled that only a handful of pharmacies are allowed by the government to dispense it. For a solid year, I was told that we had to go to a specific pharmacy, which I not so affectionately came to call "the pharmacy that time forgot." It was inconveniently located, was open limited hours (closed at 6 PM on weekdays and at 1 PM on Saturday, not open on Sundays), and was staffed by the rudest bunch of people you'll ever meet. Most of the time the blood work had not been faxed, so I either had to wait an hour or come back another time. For many months, the medication could only be dispensed 2 weeks at a time, and, since Medicaid only allowed 3 prescriptions a month and Gabriel took other medication, sometimes we had to wait until the first day of the next month to get it filled. (I finally got smart and started paying for his cheaper drug out of pocket, so as to reserve the Medicaid for the more expensive drug.) The upshot was that most of the time, getting his medication involved 3 trips to the pharmacy, during working hours. Finally a couple of weeks ago, after a year of dealing with this pharmacy, and making my dissatisfaction with it well known to MHMR, someone bothered to tell me that I could go to another pharmacy on the list (even though they had told me at first that I couldn't). There was a 24 hour CVS pharmacy on the list. I thought my problem was solved!

But, no, last Friday I took the scrip to CVS, and they said they'd have to wait for the bloodwork and that they had to order the medication anyway, since they didn't have it in stock, so it would be Monday before I could get it. I went back Monday after work and told them I was there to pick up Gabriel's meds. They said they had to get it ready. After I waited 45 minutes, they called me to the counter, to tell me that they hadn't got the bloodwork. I called MHMR the next morning, and yes, they had faxed the bloodwork. So they said they would fax it again. I went back (are you keeping count? my third trip), and was told they hadn't got the bloodwork. I informed them that it had been faxed 2 times! They let me have the medication. Time to try yet another pharmacy on the list...

Well, my point is this...if everyone agrees that it is a challenge to keep schizophrenics on their meds, it seems that it would be a good idea to make getting the medication as easy as possible. Every time this happens, I think about how frustrating it is to me and how much time and effort it takes to get 2 or 4 weeks worth of medication. And I can't help but think about how, if Gabriel were living on his own, there is NO way he would be able to jump through all these hoops to get his meds. There's the lack of motivation, there's the poor memory, there's the lack of transportation. He would have been off his meds long ago if it were up to him to get them.

So the next time you see some expert, wringing his hands on the news after some tragedy, talking about how "those people" won't take their meds, call up the local news affliliate and tell them that the system bears a large share of the responsibility.


Thom said...

As someone who is on far more medication than I ever imagined I would be, or care to be on, I know how difficult a refill can be for the simplest of medication. I know about the fax frustrations and being told “Your doctor hasn’t called back yet.” But I am mentally clear (mostly) and have transportation… I just can’t imagine how infuriating this must be.

Galen said...

"On far more medication than I ever imagined I would be" and me both, Thom! When I see my bag o'pills, I feel like I'm turning into my mother!

Pirate Aggro said...

This is a constant source of frustration in my job. People with serious mental illness commit crimes as a result of their mental illness, land in jail, eventually start on medication, get a little better, are released, can't afford or can't get their medication or don't have effective case management (if they have it at all) so they end up in jail again.

Our system is BROKEN to say the least. We would rather lock people up than effectively treat their mental illness.

Joy said...

I appreciate the comment "The pharmacy that time forgot" - the same can be said about people with mental illness, schizophrenia specifically, as "the people that society forgot."