Medication non-compliance is a major risk factor for relapse. This is the case for psychotic illnesses (eg, Marder 1998) as well as depression (eg, Geddes et al 2003). There is clear evidence that maintenance medication and taking medication as prescribed significantly reduces the risk of relapse.

Despite this, many people do not take their medication as prescribed. For example, it is estimated that fewer than 10% of people with unipolar major depression take the appropriate therapeutic dose of medication, and more than 20% fail to even fill their first prescription (Keller & Boland 1998). Furthermore, people often discontinue their medication long before it is advised by their medical practitioner. Adherence to taking antipsychotic medication is particularly problematic, and a wide range of factors, including unpleasant side effects and poor communication with doctors, have been shown to contribute to this reluctance (see Marland & Cash 2001).

The majority of interventions aimed at preventing relapse, focus on compliance with medication. Mueser et al (2002) differentiate between programs that use psycho-education to encourage taking medications as prescribed and cognitive-behavioural programs that use techniques such as behavioural tailoring, simplifying the medication regime, motivational interviewing, and social skills training (to improve interactions with prescribing practitioners so as, for example, to be better able to discuss the side effects of medications).

From a review of eight randomised controlled trials of psycho-education, Mueser et al conclude that the psycho-education approach alone improves knowledge, but does not affect the behavioural outcome of taking medication. In contrast, randomised controlled trials of 14 cognitive-behavioural programs concluded that the majority of these programs were effective at improving the behaviour of taking medication, and that the strongest evidence was for behavioural tailoring (Mueser et al 2002). Behavioural tailoring is a particularly effective and relatively simple technique that comprises simplifying the medication routine and teaching people ways to ensure that taking medication becomes a habit by being incorporated alongside everyday activities, such as teeth brushing (see Cramer & Rosenheck 1999).