I am responsible for the care of patients on a psychiatric intensive care unit. All of our patients are detained under the Mental Health Act and many do not have capacity to consent to treatment. In my experience the most common causes for relapse are a combination of non-adherence or partial adherence to medication regimens and substance misuse.

‘Compliance therapy’ is a combination of cognitive–behavioural techniques, motivational interviewing techniques and psychoeducation, and it aims to promote a good therapeutic alliance between doctor and patient, with open discussion about the risks and benefits of medication. The therapy has been used with success in patients with psychosis and it reduces readmission rates and improves insight and adherence to medication (Reference Kemp, Hayward and ApplewhaiteKemp et al, 1996, Reference Kemp, Kirov and Everitt1998).

Relapse prevention is as important as treating the acute illness. Non-adherence to medication is an important risk factor that needs close monitoring. It is our responsibility as clinicians to ensure that our patients understand their illness, the need for treatment and the importance of engagement with the services. It is essential that this is in the context of a partnership between doctor and patient.