Shared decision-making and stigma around long-acting antipsychotic — CASC communication station

Station brief

Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar in an early-psychosis clinic. [3]

Candidate instructions. Your patient is considering long-acting injectable antipsychotic medication after partial oral adherence. Explore concerns about stigma and identity, use a shared decision-making structure, link options to personal recovery goals (for example work), avoid pejorative or coercive language, check understanding, agree a plan, and safety-net. Do not invent statute numbers or threaten compulsory treatment as a first conversational move. [1][3][4]

Candidate scenario

Your patient is 23, six months after a first psychotic episode, back at an apprenticeship two days a week. Oral antipsychotic adherence is incomplete because of daytime sedation and forgetting doses. You are discussing whether a monthly long-acting injectable might help. The patient says: "If I take an injection, everyone will know I am mental. People like me never keep jobs anyway — why try?" They appear tense and ready to leave. [1][2]

Marking domains

• Warm, non-shaming stance; no pejorative language
• Explicit recognition of self-stigma / "why try" content without colluding with hopelessness
• Team talk: partnership and goals (apprenticeship, relapse prevention, dignity)
• Option talk: oral vs LAI — benefits, harms, practicalities, uncertainty, visibility concerns
• Decision talk: elicit preference; negotiate trial or supported oral plan if LAI declined
• Link to CHIME-style recovery (identity as apprentice, hope, empowerment)
• Check understanding; agree follow-up; invite questions
• No empty threats of compulsion; if risk rises later, examiners may probe principles only [1][2][3][4]