The least worst option: user experiences of antipsychotic medication and lack of involvement in medication decisions in a UK community sample.

BACKGROUND: Treatment decision-making that fully involves service users is an aim across medicine, including mental health.

AIM: To explore service users experiences of taking antipsychotic medication for psychotic disorders and their perceptions of decision-making about this.

METHOD: Semi-structured interviews with 20 users of community mental health services, conducted by service user researchers and analysed using thematic analysis.

RESULTS: Antipsychotic medication was perceived to have beneficial effects on symptoms and relapse risk, but adverse effects were prominent, including a global state of lethargy and demotivation. Weighing these up, the majority viewed antipsychotics as the least worst option. Participants were split between positions of "willing acceptance", "resigned acceptance" and "non-acceptance" of taking antipsychotics. Many felt their choices about medication were limited, due to the nature of their illness or pressure from other people. They commonly experienced their prescribing psychiatrist as not sufficiently acknowledging the negative impacts of medication on life quality and physical health concerns and described feeling powerless to influence decisions about their medication.

CONCLUSION: The study highlights the complexity of agendas surrounding antipsychotic medication, including the pervasive influence of coercive processes and the challenges of implementing collaborative decision-making for people with serious mental health problems.