Addressing the Challenges of Anosognosia
Background:
Anosognosia is a significant barrier to treatment that presents as a lack of insight or awareness. It affects those with psychotic disorders such as schizophrenia and bipolar disorder. Anosognosia is a very common symptom of these illnesses and prevents about half of those with severe mental illnesses from realizing they are ill. Consequently, they are unlikely to voluntarily ask for or accept hospitalization or medical treatment, and more generally, less likely to advocate for their needs. In these cases, where an individual with untreated and/or escalated severe mental illness refuses treatment as a result of anosognosia, and meets criteria set out in provincial mental health acts, this legislation provides the only opportunity to restore the individual to wellness.
Severe mental illnesses that are left untreated due to anosognosia, can lead to lifelong suffering. Without proper treatment, these illnesses typically worsen over time, leading to increased symptoms, increased distress, and functional impairment. This, in turn, affects the individual’s ability to work, maintain relationships, and take care of themselves.
Early, effective intervention and appropriate treatment, which includes medication, psychotherapy, psychoeducation about their illness, psychosocial rehabilitation, and support from mental health professionals, can significantly improve outcomes for individuals with a severe mental illness. It's crucial for those experiencing symptoms to receive help as soon as possible. It is crucial that we recognize anosognosia as the serious dimension of illness that it is and adjust the way we treat those who have it; treatment provides them with the best possibility of stabilization and recovery.
Some mental health acts in Canada are designed to get the individual treatment – but others not - if the individual refuses. Provincial mental health acts are primarily used to prevent harm to the individual or to others. Harm, in this this context, relates to physical harm (deliberate or unintentional), but may, in some provincial mental health acts, extend to the progression of the individual’s physical or mental deterioration as a result of the mental illness. Anosognosia prevents people from doing what they need to do to stay well; this is one of the reasons jurisdictions have mental health acts: to allow for treatment when an individual is unable to recognize that they have a mental illness.
Position:
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Early, effective treatment is crucial for preventing relapses and promoting more positive outcomes.
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Involuntary hospitalization and treatment is often required in order to protect those who have anosognosia and meet the criteria set-out in provincial mental health acts in order to provide a chance of recovery.
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Clinicians and families need to be offered education about the nature of anosognosia, and how to communicate effectively with someone experiencing psychosis.