Patient Perspectives on Long-Acting Injectable Medications During Psychiatric Hospitalization

Long-acting injectable (LAI) medications are an important treatment option in psychiatry and are associated with improved adherence, reduced relapse, and decreased risk of hospitalization compared with oral formulations.^1–3 Despite these benefits, LAIs remain underutilized in routine clinical practice, with persistent patient-, clinician-, and system-level barriers to uptake.^4,5

Clinician-level barriers include assumptions that patients will resist LAIs and concerns about perceived coercion associated with injectable treatment.^5,6 These concerns may be particularly relevant in safety-net settings serving predominantly Black patient populations. However, studies examining patient perspectives suggest a more complex picture. Patient attitudes toward LAIs are heterogeneous and shaped by prior experience, information provided, and clinical context.^7,8 Some studies have found that patients may be more open to LAIs than clinicians anticipate, especially when options are clearly explained and offered collaboratively.^8,9 In addition, population-level studies demonstrate racial and ethnic differences in LAI prescribing patterns, highlighting the importance of understanding patient perspectives and treatment context in shaping acceptability and engagement.^10,11

Despite this, relatively little is known about how inpatients think about LAIs. This is important because inpatient psychiatry represents a key moment in treatment, when medications are often initiated or reconsidered during acute illness, and when LAIs may be introduced in the context of relapse or nonadherence. To better understand patient perspectives in this setting, we conducted a pilot study to characterize patient perspectives on LAIs during inpatient care.

METHODS

Study Design and Setting

We conducted a prospective, observational pilot study of patient perspectives on LAI medications among adult inpatients on a voluntary psychiatric unit at Howard University Hospital, an urban academic safety-net hospital in Washington, DC.

Participants

Adult patients (aged ≥18 years) admitted to the inpatient psychiatric unit were eligible. Inclusion criteria included the ability to communicate in English and to engage in a brief, voluntary conversation at the time of approach. Patients were excluded if they demonstrated severe agitation, intoxication, or acute medical instability that precluded participation.

Procedures and Measures

Members of the inpatient clinical team reviewed the unit census and identified patients who were appropriate to approach based on clinical status. Patients who were not clinically stable at the time of screening were not approached then and could be reassessed on subsequent days if they remained hospitalized. Research staff then approached these patients during hospitalization, provided a brief verbal description of the study, and obtained verbal informed consent prior to participation. Participants were explicitly informed that participation was voluntary, would not affect their clinical care, and that responses were being collected for research purposes only. Responses were not communicated to the treating clinical team or used to inform treatment decisions, and research staff were not involved in clinical decision-making.

Data were collected between February 2025 and April 2025 using a structured, investigator-developed worksheet designed for clinical feasibility in the inpatient setting. The worksheet assessed prior LAI exposure, perceived experience, and current treatment preferences. The present analysis focuses on responses to the LAI subsection. Responses were recorded on paper and entered into a secure, HIPAA-compliant REDCap database. The instrument was not validated and was used for pragmatic pilot data collection. The study was approved by the Howard University Institutional Review Board (IRB-2025-2174).

Analysis

Analyses were descriptive. Responses to each LAI-related item were summarized using counts and proportions. No inferential statistical analyses were performed given the pilot nature of the study and the small sample size.

RESULTS

During the study period, 51 patients were admitted to the unit, of whom 30 (59%) participated in the study. The mean age of the participants was 46.8 years (SD=14.1). The sample included 19 men (63%), 9 women (30%), and 2 nonbinary individuals (7%). Most participants identified as Black (n=26, 87%), with smaller numbers identifying as white (n=3, 10%) and American Indian/Alaska Native (n= 1, 3%). Two participants (7%) identified as Hispanic. Primary diagnoses included schizophrenia spectrum disorders (n=7, 23%), bipolar disorder (n =7, 23%), depressive disorders (n=3, 10%), and substance use disorders (n=13, 43%). Participants had been hospitalized for a mean of 3.7 days (SD=2.9, range=1–11 days) at the time of the interview.

Most participants reported no prior exposure to LAI medications (n=22, 73%), while 7 reported prior use (23%), and 1 participant was unsure. Among those with prior LAI exposure, experiences were mixed: 2 participants (29%) reported them as mostly helpful, 2 (29%) as neutral, and 2 (29%) as not helpful. One participant who had recently received an LAI reported not yet having an opinion.

When asked about current treatment preferences, 10 participants (33%) indicated that they would consider an LAI, and 8 participants (27%) reported that they were unsure and would want to discuss LAIs further. Ten participants (33%) stated that they preferred oral medications, and 2 participants (7%) preferred not to say.

DISCUSSION

In this pilot study of inpatients admitted to a psychiatric unit at a safety-net hospital, we found that patient perspectives on LAI medications were heterogeneous and reflected substantial openness rather than fixed resistance. Only one-third of patients reported a clear preference for oral medications, with most patients expressing openness to consideration or further discussion rather than a fixed preference against LAIs. These findings suggest that patient perspectives on LAIs during inpatient care may be more nuanced than is often assumed in clinical practice.

Our results suggest that a primary barrier to LAI use in inpatient settings may not be patient resistance but rather a lack of structured discussion and opportunity to consider these options. Prior work has highlighted clinician assumptions and communication gaps as barriers to LAI use.^5,6 In our sample, most patients had not previously received an LAI, and among those who had, experiences were mixed, suggesting that prior exposure alone may not determine current preferences. This aligns with studies demonstrating that patient attitudes toward LAIs are variable and shaped by context and how options are presented.^8,9 Rather than reflecting fixed preferences, patient perspectives appear to be fluid and responsive to circumstances, particularly during acute hospitalization when treatment decisions are being actively reconsidered.

The inpatient setting may therefore represent a particularly important opportunity for engagement around LAIs. Treatment options are often introduced or revisited during hospitalization, and patients may be more receptive to considering alternative approaches in the context of relapse or recent symptom exacerbation. In this context, uncertainty may be better understood not as a barrier but as an entry point for discussion, psychoeducation, and shared decision-making. These considerations may be especially relevant in safety-net settings serving predominantly Black patient populations, where treatment decisions occur in the context of broader issues of trust and prior experiences with the mental health system. Approaches that emphasize transparency, patient preferences, and collaborative decision-making may be particularly important when discussing LAIs in these settings.

These findings also point to potential directions for future work. Psychoeducation interventions delivered in the inpatient setting are feasible and have been shown to improve outcomes such as knowledge, coping, and engagement.^12–14 Inpatients are also at elevated risk of relapse and readmission,^15,16 and LAIs have been associated with reduced relapse and hospitalization,^1–3 suggesting a strong alignment between clinical need and intervention. Shared decision-making approaches and decision aids have been shown to improve patient engagement and involvement in treatment decisions in psychiatric care but have not been widely applied to LAI decision-making in inpatient settings.¹⁷ Future research should focus on developing and piloting brief, patient-centered approaches to discussing LAIs during hospitalization, with the goal of translating patient openness into informed treatment decisions. Such efforts could leverage multidisciplinary team members, such as pharmacists, who are well positioned to provide structured medication education and counseling. Additional studies could evaluate whether systematically eliciting patient preferences and communicating them to the treating team improves shared decision-making, LAI uptake, and patient-centered care. These approaches should be designed to fit within routine inpatient workflows and evaluated for their impact on patient engagement, uptake of LAIs, and perceptions of trust and coercion, particularly in safety-net settings.

This study has several limitations. The sample size was small and drawn from a single inpatient unit. The assessment was brief and not derived from a validated instrument. The sample included a heterogeneous diagnostic population, and responses were obtained during acute hospitalization, which may influence patient perspectives. Participants were prescreened for clinical stability, which may bias findings toward more stable patients and limit generalizability to more acute states. The study was also conducted on a voluntary inpatient unit, which may limit generalizability to settings that include involuntary admissions as patients in this setting may be more willing to discuss medication options than those in involuntary contexts. Despite these limitations, these findings provide a pragmatic, real-world snapshot of patient perspectives during a critical point in care and suggest that many patients may be open to considering LAIs when given the opportunity for informed, collaborative discussion.

Article Information

Published Online: September 24, 2026. https://doi.org/10.4088/PCC.26m04258
© 2026 Physicians Postgraduate Press, Inc.
Submitted: April 23, 2026; accepted June 17, 2026.
To Cite: Alim T, Frazier A, Brooks M, et al. Patient perspectives on long-acting injectable medications during psychiatric hospitalization. Prim Care Companion CNS Disord 2026;28(5):26m04258.
Author Affiliations: Howard University College of Medicine, Washington, DC (Alim, Rolin); Department of Psychiatry and Behavioral Sciences, Howard University Hospital, Washington, DC (Alim, Frazier, Rolin); Department of Pharmacy, Howard University Hospital, Washington, DC (Brooks).
Corresponding Author: Stephanie Rolin, MD, MPH, 2041 Georgia Ave NW, Howard University Hospital 5th Floor, #5B01, Washington, DC 20060 ([email protected]).
Financial Disclosure: Dr Alim reports a relationship with Evon Medics. Drs Frazier, Brooks, and Rolin have no financial disclosures.
Funding/Support: None.
Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of Howard University Hospital or any affiliated institutions.
Acknowledgment: The authors thank Leeroy Smith for assistance with IRB coordination and regulatory support, Angela Sharples for administrative coordination and ongoing project support, and Emmanuel Ebiringa for assistance with data management. They also thank the 5S inpatient team for their efforts in identifying and referring patients and the students who assisted with patient recruitment and consent procedures. The acknowledged individuals have no financial disclosures.
Additional Information: In the writing of this article, the authors used ChatGPT (OpenAI) to assist with language editing. The authors have reviewed the content and take full responsibility for the content of the publication.
ORCID: Stephanie Rolin: https://orcid.org/0000-0002-0415-2840

Clinical Points

• Psychiatric inpatients may be more open to discussing long-acting injectable (LAI) medications than clinicians anticipate.
• Patient uncertainty about LAIs may represent an opportunity for psychoeducation and shared decision-making rather than resistance to treatment.
• Hospitalization provides an opportunity for collaborative discussions about LAIs, including multidisciplinary approaches involving psychiatry and pharmacy.