Introduction
Medication non-compliance is a pertinent issue among individuals with mental illnesses, more so those diagnosed with severe mental disorders. This report focuses on Billings, which requires a comprehensive action plan to address barriers to accessing mental healthcare services. It is crucial to identify factors that contribute to non-medication adherence among people with mental illnesses, focusing on socioeconomic and cultural barriers to gain insights into developing an action plan for intervention to improve medication access, compliance, and monitoring for the at-risk population while addressing the obstacles.
Background Knowledge on Non-Compliance
The prevalence of medication non-compliance among people with mental illnesses is alarmingly high. A study by Semahegn et al. (2020) revealed that 49% of people with major psychiatric disorders did not adhere to psychotropic medication. Specifically, 56% of people with schizophrenia, 50% of those with major depressive disorders, and 44% of those with bipolar disorders did not adhere to prescribed medications (Semahegn et al., 2020). Another study involving schizophrenia, delusional disorder, bipolar disorder, depression, and major depressive disorder patients revealed that medication non-adherence was 88.16% (Ghosh et al., 2022). Medication adherence is higher among patients in the middle socioeconomic class, those in urban areas, and those with caregivers (Ghosh et al., 2022). Factors contributing to non-compliance include patient-related factors like self-stigma and negative attitudes towards medications, health system-related aspects such as poor communication with healthcare providers, and socioeconomic factors comprising low income (Ghosh et al., 2022). The high non-compliance rates are attributable to these factors.
Geographical Location of Community
The focus is on Billings, Montana’s largest city, which, despite serving as the regional hub for health services, faces many challenges regarding mental health care accessibility. According to Bailey et al. (2021), only 13.3% of the total health provider needs are met in Montana despite 65% of its population living in rural regions. This region’s population is significantly affected by mental health issues, especially depression. It is located in the south-central part of Montana and serves a large rural population from smaller towns and Native American reservations despite being an urban center.
Cultural Makeup
Billings’ population is predominantly white, and Native Americans are the largest minority group. The area’s cultural beliefs around mental health vary significantly, especially among the Native American communities. They may prefer traditional healing practices and show reluctance to seek formal medical care due to historical mistrust of healthcare systems. Mental health stigma is rampant in white and native communities, discouraging individuals from seeking formal medical care.
Average Education Level
Billings residents have a higher high school graduation rate than the national average. However, a lower proportion of its residents have college degrees, with a moderate number of adults having a bachelor’s degree or higher. Educational levels are essential since they influence the understanding of mental health treatments, leading to better compliance.
Income/Poverty Level
Billings’ household income is slightly above the state average but below the national average. Poverty rates are moderate, impacting access to mental health adversely by limiting access to medications. This poverty rate has other implications, including limited access to decent housing and food, exacerbating mental health issues.
Unemployment Rate
Billings’ unemployment rate is low, but job instability and underemployment are still notable issues. It is worse for people with mental health conditions since it contributes to their financial instability, making it difficult for them to afford treatments and medications.
Teen Pregnancy Rate
The teenage pregnancy rate in Billings is higher than the national average, although it has been declining in recent years. Besides experiencing postpartum depression, teen mothers also experience anxiety and other mental illnesses, increasing their non-compliance with medications due to added financial pressures and responsibilities that make them unable to afford treatments.
Insurance Concerns
Most individuals in Montana rely on Medicaid or are uninsured. Insurance coverage remains low despite Billings having better access to healthcare than some rural parts. Many low-income persons do not qualify for sufficient insurance, forcing them to incur high out-of-pocket costs, and this huge financial burden contributes to non-compliance.
Transportation Issues
Billings faces numerous transportation issues despite being more urbanized than the rest of Montana. Public transportation is limited, implying people lack the means to attend regular appointments or pick up their medications from healthcare facilities, worsening medication non-compliance.
Other Socioeconomic Barriers
Other socioeconomic barriers include food insecurity and housing instability. These issues divert people’s attention away from mental healthcare priorities. Available incomes are directed to housing and food needs, leaving none from mental health medications.
Main Illnesses/Health Concerns
Billings’ residents face many mental health illnesses. They include depression, anxiety disorders, substance abuse disorders, bipolar disorder, schizophrenia, major depressive disorder, and suicide. These conditions require continuous medication management, and non-adherence complicates them.
Challenges Imposed in Practice
Healthcare providers in Billings encounter many challenges in their practice. The challenges include stigma, which prevents people from seeking help and adhering to treatment plans, and shortages of mental healthcare professionals, implying the available ones are overworked. This shortage also insinuates long wait times despite most patients being impatient, contributing to non-compliance. Another challenge is co-occurring disorders, especially substance use disorders, which complicate treatment plans besides socioeconomic barriers like financial constraints and social support systems that impact adherence efforts.
Action Plan
The Issue
This action plan focuses on medication non-compliance among individuals with mental illnesses in Billings, Montana. The high non-adherence rates to medications contribute to worsening health outcomes and increased healthcare costs, necessitating urgent interventions. It also addresses the socioeconomic barriers, stigma, and inadequate support systems that exacerbate the issue.
Resources Needed
Human resources, including mental health professionals, pharmacists, community health workers, and social workers, are needed, educational materials comprising brochures and digital content on medication adherence and technology like medication reminder apps and telehealth platforms for remote consultations are necessary. Financial resources such as grants and aid from partnerships with local organizations and the government are required to support educational programs and transportation services.
Stakeholders Involved
The stakeholders necessary to achieve this action plan include healthcare providers, patients and families, community organizations, and insurance companies. Collaboration among these stakeholders is vital in addressing the challenges and improving medication access and compliance.
The Details of the Plan
The plan will comprise educational and awareness campaigns that will provide psychoeducation for patients and families about mental illnesses, treatment options, and the need to adhere to prescriptions. Aspects to address the financial issues impacting access to care include lobbying the government to expand financial assistance programs, increasing Medicaid enrollment, and collaborating with non-profits (Carbonell et al., 2020). The plan will also involve family members in creating a support network by training them on how to assist their members with medication management. Simplifying medication regimens is also a crucial component of the plan (Elnaem et al., 2020). For example, healthcare providers can be advised to prescribe long-lasting injectable medications when appropriate and minimize the number of medicines prescribed for better compliance. Additionally, the action plan will utilize technology like smartphone apps for medication reminders and telehealth to follow up with patients in remote areas (Mason et al., 2022). This plan will promote partnerships with local organizations to provide transportation assistance for patients attending appointments or seeking to collect their medications. The final aspect of the action plan is monitoring and follow-up to ensure regular appointments with pharmacists and home visits for patients by community health workers to enhance adherence.
How This Plan Will Reduce Barriers
This plan will reduce barriers by increasing awareness about the need for medication adherence and the consequences of non-compliance. Leveraging support systems by involving family members alongside awareness creation will help overcome the stigma barrier, leading to more people seeking mental health services without the fear of humiliation. Simplifying regimens will enhance communication between patients and healthcare providers and address negative attitudes toward medications, which are notable barriers. Providing transport services will address logistical obstacles and improve access to care since more people can honor their appointments. Utilizing technology will also help address logistical issues and cut costs by ensuring patients only visit hospitals when necessary. The financial aspects of the plan will ensure that more people can access mental health services, reducing the economic barriers.
How to Evaluate the Plan
Mechanisms to evaluate the plan include conducting periodic surveys and collecting feedback from the stakeholders identified on changes in medication compliance. Evaluation will also be performed by monitoring utilization metrics of telehealth services and transportation usage. Health outcomes measurements such as emergency department visits and hospitalization rates for people with mental health issues will also help evaluate the action plan regarding its effectiveness.
Discussion/Implications/Conclusion
Improving medication access, adherence, and monitoring among people with mental health illnesses in Billings is essential in ensuring its population is healthy. This measure requires a comprehensive approach to addressing individual and systemic needs. This report reveals that promoting collaboration among stakeholders, utilizing education efforts, simplifying treatment regimens, creating support systems, and using technology can help address barriers to mental healthcare services.
References
Bailey, S. J., Oosterhoff, B., Lindow, J. C., Robecker, T., Bryan, B., & Byerly, M. J. (2021). Feasibility, acceptability, and fidelity: Extension agents teaching youth aware of mental health. Journal of Rural Mental Health, 1–13. https://doi.org/10.1037/rmh0000170
Carbonell, Á., Pérez, J. N., & Mestre, M. (2020). Challenges and barriers in mental healthcare systems and their impact on the family: A systematic integrative review. Health & Social Care in the Community, 28(5), 1366–1379. https://doi.org/10.1111/hsc.12968
Elnaem, M. H., Irwan, N. A., Abubakar, U., Syed Sulaiman, S. A., Elrggal, M. E., & Cheema, E. (2020). Impact of medication regimen simplification on medication adherence and clinical outcomes in patients with long-term medical conditions. Patient Preference and Adherence, Volume 14, 2135–2145. https://doi.org/10.2147/ppa.s268499
Ghosh, P., Balasundaram, S., Sankaran, A., Chandrasekaran, V., Sarkar, S., & Choudhury, S. (2022). Factors associated with medication non-adherence among patients with severe mental disorder – A cross-sectional study in a tertiary care center. Exploratory Research in Clinical and Social Pharmacy, 7, 1–6. https://doi.org/10.1016/j.rcsop.2022.100178
Mason, M., Cho, Y., Rayo, J., Gong, Y., Harris, M., & Jiang, Y. (2022). Technologies for medication adherence monitoring and technology assessment criteria: Narrative review. JMIR MHealth and UHealth, 10(3), e35157. https://doi.org/10.2196/35157
Semahegn, A., Torpey, K., Manu, A., Assefa, N., Tesfaye, G., & Ankomah, A. (2020). Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis. Systematic Reviews, 9(1), 1–18. https://doi.org/10.1186/s13643-020-1274-3
