title: Accounting for psychotropic medication changes in prisons: patient and doctor perspectives.
abstract: Psychotropic medicines are widely used to treat mental illness; however, people entering prison commonly report that prescribed psychotropic medicines are changed or withdrawn, adding to their distress in difficult times. Drawing on three extracts from a larger qualitative dataset in which patients and doctors were interviewed about psychotropic medication use in English prisons, we combined discursive psychological and Foucauldian discourse analysis techniques to examine how individuals accounted for medication changes. Patients used four discursive strategies to organize descriptions of medication changes: they established entitlement to psychotropic medication, questioned the clinical judgment of prison doctors; highlighted communication problems; and attributed negative health outcomes to medication regime changes. In contrast, we examined an effective defense by a general practitioner, which showed how clinical needs were prioritized over previously held prescriptions when making prescribing decisions. Wider implications for continuity and equivalence of care between prisons and the wider community are discussed.
authors.affiliation: University of Manchester, Manchester, United Kingdom lamiece.hassan@manchester.ac.uk.
authors.forename: Lamiece
authors.initials: L
authors.lastname: Hassan
authors.affiliation: University of Manchester, Manchester, United Kingdom.
authors.forename: Dawn
authors.initials: D
authors.lastname: Edge
authors.affiliation: University of Manchester, Manchester, United Kingdom.
authors.forename: Jane
authors.initials: J
authors.lastname: Senior
authors.affiliation: University of Manchester, Manchester, United Kingdom.
authors.forename: Jenny
authors.initials: J
authors.lastname: Shaw
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003142:Communication; D003266:Continuity of Patient Care / Q000458:organization & administration*; D004739:England; D005260:Female; D006282:Health Personnel / Q000523:psychology; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy*; D008603:Mental Health; D008875:Middle Aged; D010348:Patient Care Team; D010818:Practice Patterns, Physicians'; D011329:Prisoners / Q000523:psychology*; D011330:Prisons / Q000458:organization & administration*; D011619:Psychotropic Drugs / Q000008:administration & dosage* / Q000627:therapeutic use; D036301:Qualitative Research; D011787:Quality of Health Care; D055815:Young Adult
chemical_list: D011619:Psychotropic Drugs
keywords: discourse analysis; medicine; mental health and illness; prisons, prisoners; qualitative