Not sure how to go about this. I have a patient who is bipolar (not sure if 1 or 2, diagnosed by a previous provider, can’t get records and history is shotty), also has adhd, anxiety and what sounds like c-ptsd. Came to me after hospitalization with SI, still pretty depressed but I got her to a semi-good place with a new mood stabilizer but bc of side effects switched it to a diff one, and she completely went off the rails, didn’t pick it up, then stopped ALL her meds (ssri, stimulant for adhd, seroquel, trazodone) and became extremely depressed again. I started her back on the mood stabilizer first but again she never picked it up. Was having SI again so brought herself to the hospital for a few days, they discharged her when she was “stable” , on a new antipsychotic but was still having SI but no plans (was too tired to do anything). She always says she wants to get better and be happy and I have told her kindly but firmly that she needs to take the medication prescribed if she wants to get better but she keeps not picking it up or forgetting to take. She missed her follow up after that, I had my office call to check in on her and she said she was fine just couldn’t mAke the appt and rescheduled. Well she missed that one too. She’s missed/cancelled 3-4 appointments previously in the past few months. All of our patients get appt reminders both in their email and via text with a link to the virtual waiting room (I do telehealth) so for my established regular patients I don’t always send the link when their time comes and they haven’t shown because I know they have the info but for this patient, I feel like if I don’t send the link and she doesn’t show and something happens to her, I’ll feel guilty like I should have made more effort. But at what point do you stop hand holding/reminding/checking in. Every time I do see her and she’s just so hopeless I feel bad but I can’t force her to pick up her meds and everyone she misses an appt it’s obvious her mental health is going to suffer more.