Saturday, May 06, 2006

Pill Line

[Posted by ClinkShrink]

Happy Birthday, Siggie!

I found a pertinent Freud quote in honor of the day, particularly relevant to correctional work:

The first human who hurled an insult instead of a stone was the founder of civilization.
And now for something completely different....

Imagine working in a hospital where the patients change rooms every night and your unit gets 350 new admissions every day. Imagine dispensing medication to hundreds of inmates who come to your pharmacy twice a day to pick up their psych meds. I think of medication times (or "pill line" in correctional idiom) as a kind of March of the Penguins for prisoners. When people wonder why inmates don't always get their medications, I can tell you that some inmates decide they just don't want to face the daily migration. Sometimes they don't want to get up out of bed, or they don't want to take the chance of missing commissary or they have a visit scheduled. Maybe they are afraid of being ridiculed by other inmates. Maybe it's raining out and they don't want to cross the recreation yard. Maybe they are afraid of having confrontations with other inmates during the hour-long wait in line. More likely, the medications work so gradually and the effects are so subtle that they think treatment simply "isn't worth the hassle".

When I read about the effort required to persuade patients to take Lithium my first thought was, "That's so true!". But in addition to dealing with medication side effects, I also have to convince them that going down to get the medication is worth it. Fortunately, I have some research on my side. In the early days of lithium research the first research subjects were prisoners with a history of violence. Lithium was found to cut the rate of infractions in half. This is a strong selling point for my patients---"take your medicine because it's a good way to stay out of trouble."