Antipsychotic Deprescribing Analyzed as a Wicked Problem

Abstract

The values and ideologies underpinning mental health care are evolving, shifting from a narrow focus on symptom reduction to a broader emphasis on recovery, human rights, and enhancing quality of life. To overcome the risk that health care systems will pay lip service to these emerging values and remain stuck in familiar one-size-fits-all solutions in clinical guidelines, there is a need for reshaping the clinical and scientific inquiries, by broadening our research questions and the epistemic methods employed. In this paper, we use the models of “tame” and “wicked” problems to understand this mismatch between current clinical guidelines and emerging recovery-oriented health care. We use the example of decisions on deprescribing antipsychotic medication, with its multiple inherent dilemmas and paradoxes, as a wicked problem in need of transdisciplinary solutions. Finally, we emphasize the value of preserving people’s dignity of risk-taking and conclude that the focus must shift from ensuring adherence to how we can best support people’s efforts to pursue meaningful lives, in line with the values of contemporary, recovery-oriented mental health care.