Speculations On Ways To Improve Medication Adherence in Mentally Ill Homeless People
I can't imagine all the barriers to getting and taking meds there are for people experiencing homelessness | ~1143 Words
{Disclaimer: I’ve never had a job working with mentally ill homeless people, and I’ve only ever been a mentally ill housed (non-homeless) person.
I.
I read the abstract of this article (Rhoades, 2017), and almost nothing besides that, but noticed it mentions cell phone usage among homeless adults in CA:
“The vast majority (94%) currently owned a cell phone, although there was considerable past 3-month turnover in phones (56%) and phone numbers (55%). More than half currently owned a smartphone, and 86% of those used Android operating systems. Most (85%) used a cell phone daily, 76% used text messaging, and 51% accessed the Internet on their cell phone. One-third reported no past 3-month Internet use. These findings suggest that digital technology may be a feasible means of disseminating health and wellness programs to this at-risk population, though important caveats are discussed”The rest of Part I of the post hinges on homeless people indeed having access to cell phones.
I’ve read Details That You Should Include In Your Article On How We Should Do Something About Mentally Ill Homeless People, including some of the cases in which people end up not receiving medication that would treat symptoms of their mental illnesses.
I don’t know if any of these “things that can be done” I’m bringing up are being done already or would be effective at all, so these are just some thoughts/questions/IDEK after reading about typical cases.
“The patient is confused and sedated, which is a common side effect of antipsychotic drugs, and maybe if they made it to the doctor then the doctor could recommend something that would prevent this (realistically only the top 5% of doctors catering to the homeless will go this far), but they can’t make it to the doctor because they’re confused and sedated.” “The patient went to their appointment with the welfare bureaucracy that was supposed to give them a free subway pass, but in the waiting room they spotted a drug dealer who had a grudge against them, so they left because they worried they’d get beaten up.”
Are appointments via phone (preferably with no requirement of Zoom or a smartphone in particular) with doctors (or with bureaucracy people!) legal?
“They lose their prescription and don’t know how to get another one. Or they call their insurance, insurance whines “these drugs cost $500 and you lost your last prescription too, we’re not paying”, and they don’t know what to do.” “The patient was in the hospital with sepsis during their psychiatrist appointment, and nobody told them how to get an alternative psychiatry appointment.”
Does anyone (eg a nurse or a bureaucracy person) offer each homeless person a contact number with their psychiatrist or someone who’ll reach their psychiatrist, and ask to make sure it’s saved in their phone contacts?
Do they have anyone (eg a nurse or a bureaucracy person) texting or calling people about appointment reminders the day before the appointment, and making sure they are still available at those times?
I would assume that pharmacies already send text notifications and/or call letting people know when a prescription refill is ready, since that’s what my pharmacy has been doing.
“The patient wrote their appointment time on a piece of paper, which they left in their tent, which got flooded in a rainstorm and all their stuff was washed away.”
Are mentally ill homeless people prioritized when it comes to appointment times? It might be easier for someone to come consistently if their appointment is always — for example — on a Wednesday, or always 1:00 PM, or always Wednesday at 1:00 PM. The mentally ill homeless people’s appointments could be booked further in advance, and the mentally ill non-homeless people could have the remaining time slots.
Can you give people sturdier cards with information on resources (eg numbers to call, addresses, appointment times and dates) on them?
II.
Here are some slightly unhinged ideas that might not produce desirable results, and/or have too many downsides:
Would changing visual aspects of medication, and/or medication containers reduce medication theft?
“Another homeless person steals their pill bottle thinking it might be opioids; later they will grind them up, snort them, and have the worst day of their lives.””
The antipsychotic tablets I’ve received in my life have been indiscriminate white pills, and prescription bottles I’ve received for various prescription medications a translucent-y orange or green. I don’t know if this would work (maybe opioid tablets come in all shapes and sizes, maybe people will grind and snort a tablet regardless of how it looks like), but to discourage stealing of antipsychotics, maybe antipsychotic tablets could be manufactured to be a colour and/or shape that opioid tablets usually aren’t.
(I’m not sure if opioid manufacturers have any incentive to make opioids look like antipsychotics.)
Maybe various categories medications can be given to people in different coloured containers (eg red containers for antipsychotics, blue for antidepressants) — but maybe that wouldn’t matter because someone could easily assume a person is hiding opioids in any prescription medication container, and steal the container anyway.
Maybe if containers were transparent and tablet colours could be more easily seen, and if the colour of tablets can de-incentivize someone from stealing, that could reduce cases of prescription medication theft, but maybe this barely matters.
Would increasing rewards for obtaining prescription for mentally ill homeless people medication increase medication adherence?
Sometimes not all the reward in the world can make a task possible; there’s a good chance this wouldn’t work at all, and would be a waste of resources. But maybe people will prioritize and make it to more appointments with doctors and go through all the steps necessary to obtain prescriptions if going to all the necessary locations to do those things were more rewarded.
Maybe each time a prescription is given to homeless person (…if there’s an electronic medical database that identifies whether someone is homeless or not), or if a homeless person makes it to their doctor’s appointment, they could be given a small amount of cash, or a coupon for a MacDonald’s meal or similar meal at a popular and convenient restaurant.
Would increasing education on mental illnesses (eg in compulsory school, IP, jail) increase medication adherence?
This one is less about improving access of medications to mentally ill people, and more about getting them to voluntarily want to adhere to antipsychotics in the first place.
I think that compulsory schooling should include more education about psychotic illnesses and their treatment options.
Maybe courses could be made available on psychotic illnesses and treatment of them, including education on the benefits of antipsychotics, and consequences of psychosis, and people could have a reduced sentence to jail or stay in IP for attendance to these courses.
(…Or you could send people to jail if they don’t attend these courses.)
