Psychiatric Medication Treatment Plans: Part 1 (Introduction)

Medication tablets and capsulesIn Massachusetts, we have a document which follows a person’s behavior-modifying meds. It’s called a Psychiatric Medication Treatment Plan/Consent. It is typically authored by the DDS provider agency (sometimes I write them) and documents psychiatric medication treatment (its back-story, current treatment regimen, historic response, prior treatment tries/fails/successes, and reference to non-drug treatment modalities in use.

The goal of this plan is to keep a person’s psych meds in line with real need. This document is a communication tool, a teaching tool and a legal tool. As a legal tool, it serves to document the informed consent of the person (or her/his guardian). As a communication tool, it’s intended to convey a person’s need for support across time through a changing array of caregivers, professionals, and providers. Why do we need this?

Objective, not just subjective

Well, imagine Joe is going to his three-month psychiatric medication review. Joe’s regular caregiver couldn’t bring him, so Bill, a relief staff-person, comes in. Bill meets Joe for the first time on the afternoon of the appointment. Joe doesn’t communicate verbally, but does use a few signs, and personalized sounds and facial expressions. Bill probably shouldn’t be there in the first place. The only real service his orientation and training are qualifying him for at this point is driving the car. But we’re also expecting him to advocate for Joe and to support the psychiatrist to make informed decisions! How on earth can he do that?

First, he needs to learn Joe’s communication style, but that’s another discussion. Next (and where we’ll focus): how can Joe’s response to treatment be effectively conveyed to the prescriber? If we want the prescriber to make good decisions (taper or titrate doses, initiate therapy, refer to another practitioner) we need to give good information. If we’re supporting someone in their home 24/7, no one person is going to have the whole story without a trusted system of recorded observation and documentation. The best we could do without data is give our impression of how a person is doing, which would be entirely subjective. To give powerful, potentially dangerous medications ordered on the basis only of shifting, subjective data is unreasonable and unnecessary.

A reliable system that connects the person, the prescriber, the caregivers and the family/guardians is essential. This system needs to focus attention on specific mental-health symptoms once they’ve been identified as troubling, and connect their intensity with the efforts made to relieve them. Only with such a system can a person be protected from over-treatment, under-treatment, or neglect based on a lack of advocacy or a lack of objective data.

Who gets a Psychiatric Medication/Treatment Plan?

DDS requires this for persons under legal guardianship who are taking behavior-modifying medications. These can include (but not be limited to):

  • Antidepressant meds: e.g., Celexa, Zoloft, Prozac…
  • Antianxiety meds: Ativan, Klonopin, Zoloft…
  • Antipsychotic meds: Abilify, Clozaril, Geodon, Risperdal, Seroquel, Zyprexa… (in Massachusetts, a court-appointed monitor is required if persons under guardianship are treated with meds from this category)
  • Mood-stabilizing meds: Lithium, anticonvulsants like Depakote and Lamictal prescribed for mood stabilization…
  • Sleep/insomnia meds: Ambien, Lunesta, melatonin, valerian

To be honest, meds for insomnia wouldn’t be in the same class with the psychiatric meds if I had my way. The support and protections needed to helpfully but not excessively help someone sleep are different and much more narrowly focused. We kind of have to shoehorn the Psychiatric Medication/Treatment Plan to make it work. It is, however, required in Massachusetts to do it this way at the moment.

At my agency, we’ve implemented plans for persons not under guardianship to extend similar protections and supports to people who can or do give their own consent.

 

Next: The plan itself….

(Note: The situation might be very different for a person whose disability allows him/her to effectively self-report symptoms and self-advocate concerns.)