Introduction: Benzodiazepines (BZDs) are commonly prescribed to psychiatric patients. However, there have been few studies evaluating BZD refusal among patients with psychiatric disorders during the dispensing process. Thus, this study aimed to determine 1) the factors associated with BZD refusal during the dispensing process and to determine 2) the association between BZD refusal and psychiatric medication adherence among patients diagnosed with depression or schizophrenia. Method: This study was conducted at the Specialist Clinic Pharmacy, Jerantut Hospital, Malaysia, from May 2018 to June 2018. BZD refusal status was determined after the dispensing process, and general information on BZD was determined using a questionnaire developed by the researchers. Medication adherence was assessed using the Malaysian Medication Adherence Scale (MALMAS). Results: Overall, 75 patients with psychiatric disorders participate in the study. Participants had been on BZD treatment for a mean of 32.8± 21.6 months. The BZD refusal rate was 38.7%. BZD refusal was significantly associated with several factors. A one-year increase in age resulted in increased odds of BZD refusal by 1.16 times (95% CI 1.05-1.27). Other factors were male gender (OR,9.14; 95% CI, 1.17-71.27), being single (OR,15.07; 95% CI, 1.12-184.28), the diagnosis of schizophrenia (OR,13.45; 95% CI, 1.75-10.33) and not having history of illicit drug use (OR,20.63; 95% CI, 2.49-171.0). Medication adherence was not associated with BZD refusal. Conclusion: BZD refusal was significantly associated with demographic factors such as increased age, male gender and being single and diagnosis factors namely schizophrenia diagnosis and not having history of illicit substance use. Thus, the need for BZD in these groups of patients should be reviewed regularly.