Healthcare professionals are accustomed to dealing with a variety of patient types and personalities. As a psychiatrist, psychologist, mental health nurse, or behavioral health specialist, you may be challenged by non-compliant patients, or those who may exhibit aggressive behavior — while in your care.
Understanding the reasons behind non-compliance can help you determine the most appropriate — and constructive — actions or next steps. While you can’t coerce your patients to do anything they don’t want to, you can develop a rapport with open communication and understanding. This will help ensure your patient follows directions in the name of compliance, safety, and long-term physical and mental health.
What Does “Non-Compliant Patient” Mean?
It’s common for patients to be unwilling to take a prescribed medication or follow a prescribed course of treatment. They may not listen to your instructions, and they may even become hostile or precarious in their refusal — or hesitance — to comply. These situations can escalate quickly from simple medication non-compliance to actively threatening the culture of safety that behavioral health professionals strive to create and maintain.
Non-Compliant vs Non-Adherent: What’s the Difference?
The term “non-compliant patient” generally refers to a patient who intentionally refuses to take a prescribed medication or does not follow the doctor’s treatment recommendations. A non-adherent patient, on the other hand, refers to someone who unintentionally refuses treatment. This resistance could be due to a variety of reasons, such as experiencing confusion or feeling overwhelmed.
From mental illness to other mental deficiencies, there are a number of causes for non-compliant behavior. It’s important that professionals entrusted with treating patients who have trouble fulfilling clinical requests or processing commands remain patient, resilient, and professional under all conceivable circumstances.
What is an Example of a Non-Compliant Patient?
Examples of non-compliant behavior include:
- Not following or challenging the caregivers’ instructions or rules of the facility
- Missing appointments
- Not taking medications or following treatment regimens as prescribed
- Not taking medications in the prescribed dosages or frequency
- Defiance and refusal to comply
Non-compliance and non-adherence rates can vary greatly by diagnosis. For example, medication nonadherence — especially for those with chronic conditions like hypertension or diabetes — is extremely high, with as many as 40-50% of patients failing to take their medications as directed. This leads to at least 100,000 preventable deaths per year.
In fact, for people diagnosed with schizophrenia, noncompliance rates can vary widely, from 20 to 89%. Noncompliance is a serious concern because it can be related to serious negative consequences like relapse, hospitalization, or self-harm attempts.
Understanding the Non-Compliant Patient
Patient non-compliance and non-adherence is known to be widely prevalent in mental health settings, especially when it comes to patients not taking their prescribed medications. It’s paramount for healthcare providers to remain calm and compassionate while doing their best to understand the cause of the non-compliant behavior.
What is the reason for patient non-compliance?
While there are several different causes, these are a few of the common reasons for non-compliance and non-adherence:
- Cost and affordability
- Lack of understanding/comprehension of advice, whether due to language barriers, cognitive abilities, being afraid to ask for clarification or other reasons
- Mistrust or a lack of strong patient-provider relationship
- Drug or alcohol dependence
- Medication side effects
- Difficulty managing treatment regimen
- Forgetfulness or inattention
- Transportation limitations
- Stigma associated with the diagnosis
In addition to those listed above, one of the most common reasons for non-compliant patient behavior is denial — the patient may not believe they have a condition that needs to be treated. Known as anosognosia, this symptom affects many individuals with severe mental illnesses such as bipolar disorder and schizophrenia.
According to the National Alliance on Mental Illness (NAMI), early studies of anosognosia indicated that approximately 30% of people with schizophrenia and 20% of people with bipolar disorder experienced “severe” lack of awareness of their diagnosis. Healthcare providers must understand that most of their patients aren’t ignoring recommendations out of a desire to make their jobs more difficult — rather, there are deep underlying reasons for the behavior.
In the paper “Understanding Noncompliant Behavior: Definitions and Causes,” Dr. Fred Kleinsinger recommends asking questions to make sure the patient understands both the health problem and/or the consequences of non-compliant behavior. He implores fellow physicians to see non-compliant behavior as “a challenge — not a failure.”
5 Tips for Treating Non-Compliant Patients
Appropriately handling non-compliant patients while maintaining composure and professionalism is not always easy, but it’s important to do because it both increases the chances of achieving the desired result and doesn’t put the noncompliant person in control of the situation. So, with all of these complex dynamics at play, how do you care for non-compliant patients?
- Be understanding. Put yourself in the patient’s shoes and make every effort to be empathetic, thus recognizing the challenges they may experience when trying to understand your requests. While this may be your intention with every patient interaction, we recognize that you are only human. Healthful breathing techniques may help you maintain rationality and professionalism when things feel unmanageable.
- Educate. As mentioned, your patient may exhibit non-compliant behaviors because they simply do not understand the diagnosis or instructions for treatment. It’s in both of your interests to take responsibility for helping them. Ask them to repeat back to you what you’ve said, or take the time to describe your instructions in their own words — or words they are likely to comprehend.
- Document everything. While it’s already part of your daily schedule, it’s particularly important to maintain meticulous records when dealing with non-compliant patients. By documenting what you discussed with the patient, all diagnosis and treatment plans, and any questions or concerns the patient — or their visiting friends and family — may have, you’ll maintain a verified record to reference in the event of non-compliance.
- Set boundaries and enforce them. Sometimes a patient exhibits non-compliant behavior because they are stubborn or have the tendency to test how far they can push your buttons. Don’t let these common personality characteristics frustrate or disarm you. If you impose limits and enforce them with earnestness, you will ultimately help the patient consider the very real consequences of their non-compliance. Always be prepared to follow through with limits that you set, which is in the best interests of you as a clinician — and for them as the patient (and as the end consumer of your care).
- Avoid ultimatums. Don’t threaten a non-compliant patient with empty ultimatums, but, rather, be objective when explaining their options to them. Stay focused on the positive outcomes of being compliant which may help you gain well-earned credibility and trust. Actively avoid a power struggle, explain the potential scenarios and consequences, but always give the patient their rightful choice.
Following these steps are not foolproof, but they can help prevent an unpredictable scenario from escalating.
Interventions for Non-Compliance & Healthcare Solutions
These actionable steps will help keep you on track as you manage multiple patients, needs, and directions in maintaining a high level of care in behavioral health settings.
Increased patient education. Patient education can help patients understand the importance of following the provider’s recommendations. For medication compliance, it can be helpful to explain how the medication works, how to take it, side effects, and openly addressing their hesitancy or unwillingness.
Risk communication. Clearly communicate the risks and benefits of adhering to the treatment plan so the patient is fully informed.
Patient supervision. Whether it’s in a behavioral health facility, home health, telehealth, or another setting, frequent supervision can help ensure the patient follows instructions. This can be scaled back once compliance improves.
To improve patient supervision and patient monitoring, ObservSMART has developed innovative healthcare technology for a variety of patient populations, helping to avoid sentinel events that include self-harm, suicide, and elopement.
How We Can Help
Our tamper-resistant, Bluetooth-enabled patient wristbands were designed specifically with behavioral health patients’ safety in mind. Ideal for monitoring high-risk, non-compliant patients, these wristbands sync with a staff tablet device to ensure proper proximity when completing required observations, or safety checks.
With ObservSMART’s ability to customize observation intervals and proximity per patient, validated compliance becomes simplified, ultimately creating a safer environment of care for both patients and staff.
Contact us today to learn more about how to treat non-compliant patients, or how our proximity-based tools can ensure validated observation compliance in your healthcare setting.