ABSTRACT
While the main emphasis of this book is medical perspectives on polypharmacy in psychiatric disorders, psychosocial perspectives are equally important. There is a growing interest in the relationship of social work to psychopharmacology (1-3), with polypharmacy being a subject of particular importance. In this chapter, we will describe many of the psychosocial phenomena associated with polypharmacy, and we will specifically discuss the role of the social worker in psychopharmacological treatment.*
Polypharmacy is justifiably criticized in many settings. Social workers are among those who have perhaps been most vociferous in these criticisms. However, it is all too easy for social workers and other mental health professionals to stand apart from the medication treatment process, disagreeing from afar yet doing nothing constructive. We advocate that social workers need to be active players in the medication treatment of persons with serious mental illness (SMI). Social workers need to be engaged in this treatment process, both to maximize the
benefit of needed medications as well as to help avoid treatment with unneeded medications. Especially in the case of SMI, traditional models of single provider treatment do not suffice. Psychopharmacology is usually necessary but not sufficient by itself for treatment success. Individual psychotherapy is often helpful, though not usually by itself. Attention needs to be paid to family structures and habits, community links, social supports, occupational abilities, and rehabilitation needs. The best outcomes result from a team approach linking psychiatrists, social workers, psychologists, case managers, occupational therapists, and other mental health professionals with the client. In the last few decades, as new and more effective medications have become available for SMI, it has become essential for all members of this team to contribute to medication management. If the psychiatrist acts alone making medication decisions in a vacuum, uninformed by contributions from other members of the treatment team, then the team approach fails. Often, ineffective polypharmacy is the end result.
