Attitudes of psychiatrists, nurses and
service users towards prescribing and
administrating depot antipsychotic
medication
Claude Besenius, Eleanor Bradley and Peter Nolan
Abstract
Purpose – The aim of this paper is to ascertain the attitudes and experiences of psychiatrists, nurse
prescribers, and service users with regard to the prescription of antipsychotic medication, the route of
administration, and the extent of service users’ involvement.
Design/methodology/approach – A total of 26 psychiatrists and 12 nurses agreed to be interviewed in
phase one of this study, concerning general aspects of prescribing. In phase two, 11 of the psychiatrists
and five nurses from the first cohort took part in follow-up interviews that focused specifically on their
most recent prescribing experiences. In phase 3 of the study, 18 service users (14 male and 4 female)
were recruited, during which their experiences of having medication prescribed was explored.
Findings – This interview-based survey found that though there was some agreement between the
attitudes and perceptions of prescribers and service users, there were also some important differences
including differences with respect to the purposes of prescribed medication, when to prescribe, and
under what conditions depot medication produces optimal results. It is not always clear to service users
as to why certain medicines were prescribed nor is the information provided always understood.
A considerable amount of prescribing practice is based on assumptions.
Originality/value – Even though medication (both oral and depot) has been shown to be useful in
certain situations, nevertheless, the type of medication, dose and mode of administration continues to
be idiosyncratic and inconsistent. This paper seeks to contribute to the debate by identifying in which
pharmacological interventions for people with severe mental health problems could be improved.
Keywords Depot, Attitudes, Adherence, Psychiatrists, Psychiatry, Nurse prescribers
Paper type Research paper
Introduction
Although medication, both depot and oral, is the most commonly used treatment in mental
health care, the process of prescribing it is not without its concerns and challenges. The
diversity of drugs administered and the many reasons cited for their use suggest inconsistency
or confusion in practice (Baker et al., 2007). For instance, to what extent should service users be
involved in decision-making? How much say should they have in what and how much is
prescribed? And what credence should be given to their assessment of the efficacy of a
particular drug? (Paton et al., 2008). Adherence to medication regimens has been shown to be
generally effective in managing some of the most distressing aspects of such serious
conditions as schizophrenia and the major affective disorders (Corrigan, 2002; McEvoy et al.,
2007). However, despite this evidence, a third of service users are thought to be entirely non-
adherent, a third partially adherent and only a third fully adherent (Thornicroft, 2006). The
assumption that poor adherence is attributable to such factors on the part of the client as poor
insight, negative beliefs about treatment, side effects, and the possibility of addiction are not
entirely true (Lacro et al., 2002). Patel et al. (2005) pointed to more serious factors such as
DOI 10.1108/17556221211230552 VOL. 7 NO. 1 2012, pp. 9-19, Q Emerald Group Publishing Limited, ISSN 1755-6228
j
THE JOURNAL OF MENTAL HEALTH TRAINING, EDUCATION AND PRACTICE
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Claude Besenius is a Health
Psychologist at
Staffordshire University and
Dudley and Walsall Mental
Health Partnership NHS
Trust, Stafford, UK.
Eleanor Bradley is Head of
Research and
Development and Peter
Nolan is Professor of Mental
Health Nursing (Emeritus),
both at Staffordshire
University and South
Staffordshire and
Shropshire Healthcare NHS
Foundation Trust,
Stafford, UK.