Is refusal of treatment the same as non-compliance? If not how would you differentiate between them and what course of action would be appropriate for each? Good evening group Six. Allow me to share my views regarding this important topic. I have been informed by research that treatment refusal and non-compliance are not the same. In their paper, Gruber and Persons (2010) discuss the difference between the two topics which they agree to be totally distinct phenomena although they appear to be related. These authors go on to define treatment refusal as a situation where a patient explicitly rejects a treatment plan or part of the plan, and non-compliance as when a patient agrees to the plan but fails to adhere to it in a consistent manner (Gruber & Persons (2010). A typical example of treatment refusal from my experience would be when Mr X who presents with manic signs of bipolar denies that he has mental illness and therefore refuses to be treated. On the other hand, non-compliance would be where Mrs Y who is diagnosed with schizophrenia has commenced treatment but on discharge fails to honour discharge plan in the process missing appointments and depot injections leading to her relapse. Dealing with treatment refusal is a difficult call (Brown &Tulley 2014: Gray et al. 2010: Gruber & Persons 2010: Stuart 2013). According to Stuart (2013 p.20), ‘The relationship between the right to treatment and right to refuse treatment is complex ‘. The author states that the right to refuse treatment include refusal of involuntary admission. The author argues that forced treatment conflicts with two fundamental human rights which are: freedom of thought, and the right to behave and act as one likes if his actions do not conflict with other people’s rights (Stuart 2013). When a patient therefore refuses treatment, the treating team must evaluate each situation case by case (Brown &Tulley 2013: Gray et al. 2010: Gruber & Persons 2010: Stuart 2013). Where involuntary treatment is considered, Stuart (2010) describes three conditions that must be met prior to the involuntary therapy being prescribed: The patient must be at risk for harm to self or others, the involuntary treatment considered must be believed by the treating team to be of benefit to the patient, and the patient must be evaluated whether they have capacity to consent to treatment. When these conditions have been met, the team must inform the patient the treatment they will implement and both the beneficial and likely untoward effects (Stuart 2010). Treatment refusal for patients with no capacity to consent would therefore be addressed by initiating involuntary therapy. In the state of Queensland this process is implemented within the confines of Queensland Mental Health Act 2016 (Queensland Government 2016). The Act provides for criteria and steps to be followed in qualifying a person to be legally treated as an involuntary patient. Where a patient has capacity to consent but refuses treatment, Persons as cited by Gruber and Persons (2010) recommends other strategies such as pre-treatment phase, psychoeducation, cognitive restructuring, motivational interviewing strategies, involvement of family members and psychopharmacologist, recommending a compromised treatment plan and as a last resort, agreeing not to work with the client. My question to the group therefore is, ‘has anyone implemented any of the strategies recommended by Persons in the above paragraph and would you like to share your experience with the group?’ References: Brown, S, &Tulley, R 2014, ‘Components underlying sex offender treatment refusal: an exploratory analysis of the Treatment refusal scale- sex offender vision’. Journal of Sexual Aggression, 20, 1, pp. 69 – 84, Psychology and Behavioural Science Collection, EBSCOhost, viewed 6 May 2017. Gray, R, White, J, Schultz, M, &Abderhalden, C 2010, ‘Enhancing medication adherence in people with Schizophrenia: An international programme research”, International Journal of Mental Health Nursing, 19, 1, pp.36 – 44 doi: 10.1111/j.1447-0349.2009.00649.x viewed 8 May 2017. Gruber, J & Persons, J 2010, ‘Unquiet treatment: Handling treatment refusal in bipolar disorder ‘, Journal of Cognitive Psychotherapy, 24, 1, pp. 16 – 25, Scopus, EBSCOhost, viewed 6 May 2017. Sabin, J 2016, ‘Medication refusal in Schizophrenia: Preventive and Reactive Ethical Considerations”, AMA Journal of Ethics, 18, 6, pp. 572 – 578 Medline Complete, EBSCOhost, viewed 7 May 2017. Stuart, G 2013, ‘Principles and Practice of Psychiatric Nursing; 10th (edn), MOSBY, An imprint of Elsevier, 3251 Riverport Lane, St Louis, Missouri 63043. Queensland Government 2016 https://www.health.qld.gov.au/publications/clinical-practice/guidelines-procedures/clinical-staff/mental-health/act/implementation/examination-assesment-fact-pdf