NHS Clinicians Identify Influences on Psychotropic Medication Non-Adherence

A qualitative study of 12 psychologists and psychotherapists in a UK National Health Service mental health trust found that psychotropic medication non-adherence is shaped by patients’ beliefs, emotional experiences, relationships with services and wider multidisciplinary team dynamics. Psychotropic medication non-adherence is common in mental health services and is associated with relapse, hospitalisation and poor treatment outcomes. Earlier research has identified several influences on adherence, including patients’ attitudes towards medication, insight into their mental health condition, social support and wider health-system barriers.

Strategies to improve adherence have often focused on simplifying regimens and strengthening therapeutic alliances, while the emotional and relational aspects of medication use have remained under-investigated. The study was conducted within one NHS mental health trust and used a critical realist epistemological position. Twelve psychologists and psychotherapists were recruited through purposive sampling and completed semi-structured interviews.

Their accounts were analysed with reflexive thematic analysis following Braun and Clarke’s six-phase approach. As a qualitative investigation based on professional perspectives, the study explored how participants understood medication non-adherence rather than measuring adherence rates, evaluating a treatment programme or establishing causal effects. Five themes emerged from the interviews: identity and sense of self, internalised negative beliefs, patient autonomy and control, dynamics and decision-making within multidisciplinary teams, and facilitating patient-centred care.

Together, these themes describe non-adherence as the outcome of an interaction between a patient’s experiences of medication and the service context in which treatment is discussed and managed. Participants’ accounts indicate that acknowledging the meanings patients attach to medication is an important part of understanding why medication is not taken as prescribed. The findings also show that non-adherence was discussed in relation to decision-making across multidisciplinary teams and to efforts to facilitate patient-centred care.

The authors conclude that reflective, multidisciplinary work and attention to patients’ meanings may support more patient-centred approaches to adherence, but the interviews do not demonstrate that a specific intervention improves medication-taking. The sample was limited to 12 psychologists and psychotherapists from a single NHS trust, and the study did not include patient perspectives. Further research involving patients is therefore needed to examine how the reported factors relate to the experiences of people prescribed psychotropic medication.

Subject of Research: Psychological and service-level factors influencing psychotropic medication non-adherence in NHS mental health care

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

Article References: Din, M., McDowall, A., & Sonigra, K. (2026). Psychological factors influencing psychotropic medication non-adherence: a qualitative investigation into the perspectives of psychologists and psychotherapists in an NHS mental health trust. BMC Psychology. https://doi.org/10.1186/s40359-026-05637-5

Image Credits: AI Generated

DOI: 10.1186/s40359-026-05637-5

Keywords: psychotropic medication, medication non-adherence, qualitative research, NHS mental health care, patient-centred care, multidisciplinary teams, psychologists, psychotherapists, reflexive thematic analysis, Psychological, factors, influencing