Psychological factors influencing psychotropic medication non-adherence: a qualitative investigation into the perspectives of psychologists and psychotherapists in an NHS mental health trust

Psychotropic medication non-adherence is common in mental health services and is associated with relapse, hospitalisation and poor treatment outcomes. Existing research identifies multiple influences on adherence, including patients’ attitudes towards medication, insight into their mental health condition, social support and wider health system barriers. While strategies to improve adherence have often focused on simplifying regimens and strengthening therapeutic alliances, psychologists and psychotherapists can provide perspectives on the emotional and relational aspects of medication use, which have remained under-investigated to date. A qualitative study was conducted within a UK NHS mental health trust, informed by a critical realist epistemological position. Twelve psychologists and psychotherapists were recruited using purposive sampling and took part in semi-structured interviews. Data were analysed using reflexive thematic analysis following Braun and Clarke’s six-phase approach. Five themes were identified: identity and sense of self, internalised negative beliefs, patient autonomy and control, dynamics and decision-making within MDTs, and facilitating patient-centred care. Participants described non-adherence as shaped by patients’ beliefs, emotional experiences, relationships with services and wider MDT dynamics. These findings suggest that psychotropic medication non-adherence reflects a complex interplay between patients’ experiences of medication and the wider service context in which treatment is discussed and managed. Participants’ accounts highlight the importance of acknowledging the meanings patients may attach to medication alongside reflective, multidisciplinary work that may support more patient-centred approaches to adherence. Further research including patient perspectives is needed.