Shared decision making and psychosis – whose voice counts in the conversations about stopping or reducing antipsychotic medication

Prescribing antipsychotics has increased steadily in England over the last decade. For serious mental health conditions like schizophrenia, they are prescribed with the view of keeping the patient on them indefinitely. Antipsychotics are also prescribed off-label for conditions like anxiety or insomnia. Many people want to stop taking antipsychotics due to side-effects or the medication no longer working however when people stop taking the medication they can experience severe withdrawal effects.

Shared decisions making is a process aiming to ensure that individuals are supported to make decisions that are right for them. However, when it comes to reducing or stopping antipsychotic medication, people on the medication can often feel that they are not listened to. Shared decision making has been suggested as a key component to aid person centred care and recovery.

Currently there are no established guidelines on how to stop taking antipsychotics which may be the reason behind psychiatrist reluctance to support it and fully embrace shared decision making. However there is emerging evidence that slow and cautious reductions will improve withdrawal outcomes for people with schizophrenia who want to come off or reduce their antipsychotic medication. Little is known of the wider factors like support from health care professionals or network of friends and family on successful withdrawal outcomes and how these can be utilised in helping shared decision making.

Involving people with lived experience in the design of the study and also at analysis and designing implementation is a key part of the PhD. The lead supervisor has established links with local support groups to help with this.

This PhD will focus on exploring the factors at individual, organisational and systems level that impact the shared decision making conversations for people attempting to stop or reduce antipsychotic medication. The aim is to develop a framework for supporting people to have positive conversations about their medication focusing on the context, mechanisms, and outcomes that matter to them. The proposed methods would be qualitative in depth interviews, however depending on the candidates expertise, mixed methods could also be used. This project would be suitable for a student with a health, social science or humanities background such as sociology, psychology, pharmacy or nursing.