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Medication Non-Compliance - Fact Sheet
A relative’s refusal to take prescribed medication is a common problem families face after a brain injury
People who reject medications do so for a variety of reasons. Knowing which reasons will put the family in the best position to respond effectively.
Denial
Non-acceptance of having acquired a brain injury can be a reason for refusing medication. Even if they have been on medication previously, the person may believe that he or she is now well enough not to need it. There may be a developmental aspect also, where a young adult or youth may be endeavouring to find out ‘who he is’ and ‘what he’s capable of doing’ without medication to cloud the issue. If this is the case, it may be helpful to assist the person to identify which aspects of his/her life improved with medication.
Side effects
Unpleasant side effects can be a strong disincentive to take medication. They can induce drowsiness, nausea, weight gain, muscle rigidity and other undesirable symptoms. Feeding back this information to the doctor is an important function of a carer. Some carers keep a day to day diary of medication and side effects, which is a helpful resource to the treating physician. Changing the dosage or prescribing another medication may be arranged. If medication makes the person drowsy, making small changes in the dose and time the medication is taken (e.g. late evening) can help avoid drowsiness in the morning.
Influential friend
Some people with the best intentions give bad advice. If someone the person respects believes that medication or drugs are ‘bad’ then they could convince the person to refuse medication. Criticising will usually lead to defensiveness from both parties. Explaining to the friend the facts about the history and course of the illness and how the medications act to counter symptoms may convince the friend that non-medication regimes may be too complicated for the ill person to maintain.
Power play
As in all families, there can be a clash of wills between two or more people. If the person with an illness refuses medication, they know the caregiver will do whatever they can to gain compliance. They may try negotiation or even manipulation to get their way. Some negotiation is not a bad thing if handled sensitively and respectfully. Positive reinforcements such as doing something enjoyable after taking medication is good to keep in mind. It is better to wait until things calm down before pursuing compliance. If the person remains hostile and still refuses medication, it may take another trusted person or health worker to help.
Forgetfulness
Remembering to keep to a regular regime of medication can be difficult, especially if your thought processes are affected. Simple visual cues such as having the medication bottles in eyesight next to where the person sits or carries out daily duties are a good idea. Also, scheduling the time for medication around daily activities such as meals and walks will act as a reminder. It’s in everyone’s best interest to have the individual take responsibility for their own medication. Education about the illness, its symptoms, types of treatment available, medications and even side effects will help the carer and the person with the illness come to an informed decision. It is important not to put medications on a pedestal as a solution to all psychiatric problems. Although some medications have powerful therapeutic effects, no one knows how they will work in a particular case until they are tried.
Sometimes no matter how hard a carer tries or pleads, the person may refuse to take medication. Taking medication is a personal decision. This doesn’t mean that the reason for refusing medication is valid or reasonable, and if non-compliance continues with adverse effects professional advice should be sought.
It is not uncommon for people with brain injury to experience a lack of insight into the nature and effects of their injury, which may lead to feelings of frustration; particularly if they are forced to rely on others to do things they might normally do for themselves. As individuals gradually develop higher levels of self-awareness into the impact of their post-injury changes, the most common reactions include depression and anxiety.
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Medication non-compliance 
