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Why there is no such thing as ‘NON’ Compliance in healthcare.





This might get controversial so hold on to your seats!


This is a long overdue discussion in the healthcare and social service sectors. Many healthcare providers have heard the term noncompliance, use this term, and believe this term about some of the clients they have supported (or tried to). Nonetheless, if we are truly going to lead with empathy and make our systems of care more equitable and culturally responsive, we must erase this term and the weight of its meaning from our vocabulary and service provision.


I remember the first time I heard the term non-compliant. I had been in the healthcare/social service industry for a few short years and was working in inpatient psychiatry and outpatient mental health. The term was so common among colleagues across various departments that I almost thought it was an official clinical diagnosis!


While this setting was among the first times that I am consciously aware of hearing this term (and I will admit that as a young impressionable clinician, I certainly used the term back then), it was not the only place or the last time that I would hear it in my career. As I grew into my career, and began to shape my focus on the intersection of health equity, racial and social justice, mental health, and the human experience, I started to understand the weight and vitriol that came with the term non-compliant, across systems. Whether I worked inpatient psychiatry, outpatient mental health, substance misuse, criminal and juvenile justice, government, or child welfare, that word carried so much power.


  • In the hospital, XYZ client was non-compliant because they didn’t take their medications.

  • In outpatient, ABC client was non-compliant because they missed three follow up appointments and their case was subsequently closed.

  • In substance misuse, CDE client was non-compliant because they relapsed.

  • In criminal and juvenile justice, IKJ client was non-compliant because they got re-arrested.

  • In child-welfare, QRS client was non-compliant because they didn’t go to counseling at school.


The thing is, each time a client was called non-compliant, it conveyed that they were difficult, challenging, disrespectful, unwilling to change, didn’t want help, and defiant for questioning authority.

Whether we like to admit it or not, in the medical model, there is a very clear hierarchy and authority in the health care system between client and provider. There's hierarchy in the criminal justice system between judge/law enforcement and defendant, and there's a clear hierarchy in society and child welfare between child and adult. These assumptions, when combined with the power and authority that some of us carry in various systems, can be damaging and harmful, particularly when we think about our authority through a lens that honors intersectionality. Without curiosity, humility, empathy, and without leading with love, it is impossible to view an individual beyond our frustration and quick judgements.

Through listening, and working to form my own opinions based on curiosity, empathy, and respect for others, I learned:


  • XYZ didn’t take their medications because the medicine made them feel ‘weird’ and "very sleepy". They missed the last few visits from their family, and they were hoping to be awake and more alert when their family members came to visit them because seeing their loved ones gave them a little spark of hope.


  • ABC client that missed three outpatient appointments had to travel two hours on train and bus, to attend the therapy appointment. There were no providers available in their area and so, attending therapy (court ordered) required a two-fare zone in New York City. In route from work, they also had to pick up their two children from two different schools -- if they came to therapy first, the school would close before they were able to get back home and that would risk further child welfare involvement.


  • CDE client that relapsed after quite a few years of sobriety began having inescapable intrusive thoughts about the traumatic and horrific assault they experienced. Perhaps because their mind was healthier, the memories started flooding back—it was too much to relive the gang sexual assault and wake up screaming every night.


  • IKJ client that got rearrested had been bullied at school for months. They were labeled as aggressive and grew tired of being pushed into lockers and assaulted by groups of kids every day. The reason they came into the criminal justice system was because they tried to get help but didn't feel that the adults around them were listening and would help. One day, IKJ fought back and hurt a class mate and damaged school property, which resulted in arrest.


  • QRS client that was ‘non-compliant’ and refused to go to counseling at school felt uncomfortable with their school counselor. They felt that their counselor was unable to understand their culture, and reportedly made negative stereotypical assumptions about the client and their family because of the color of their skin. The child felt more harmed by these interactions, however, that counselor was the only option. I mean, who do you go to for help when the person helping you is causing you so much pain?

Non-compliance is a myth and one that has been used over and over in our systems to control, demean, and perpetuate bias and prejudice against groups of people and individuals. There is always a reason that someone may not follow our best professional advice. Is it frustrating at times? YES! Is it overwhelming? Incredibly! Is it scary because you/I/we know the risk? Absolutely! While all these things are true, our role is to investigate their why, while honoring their right to self-determination, and the dignity and worth of everyone we come across.


If we are going to make our healthcare systems, our healthcare education, and our society much more honoring and healing for all, it starts with us! We must be willing to listen and challenge our biases and prejudices. We must be more culturally respectful, honoring, curious, and humble. We must understand that 'non-compliance' is often a cover for a deeper pain.


Moving forward, how are you going to lead with love? Dr. Claire SPEAKS! LLC is here to support you on your journey!




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