The Disjuncture between Medication Adherence and Recovery-centered Principles in Early Psychosis Intervention: An Institutional Ethnography

To examine how recovery principles are enacted in an early psychosis intervention (EPI) clinic, we used an institutional ethnographic approach focused on how the ideology of medication adherence organizes young people’s experiences of EPI services. Methods included ethnographic observation, in-depth interviews with 27 participants (18 clinic staff, four young people, and five family members), and textual analysis of clinic documents (e.g., case files, administrative forms, policy reports). The disjuncture between service providers’ intent to provide recovery-principled care and the actual experiences of young people is actualized in institutionalized practices of informal coercion around medication adherence, which we identify as “enticing,”“negotiating,” and “taking responsibility.” We link these practices to institutional accountability, risk, and efficiencies, and discuss the need for a shift in medication management approaches in EPI settings.