HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS British Journal of Psychiatry Advances in Psychiatric Treatment All RCPsych Journals		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Submit an eLetter View responses Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Claassen, D. Articles by Priebe, S. Search for Related Content PubMed Articles by Claassen, D. Articles by Priebe, S.

Money for medication: financial incentives to improve medication adherence in assertive outreach

East London and The City Mental Health Trust, Assertive Outreach and Rehabilitation, 150 Stratford High Street, London E15 2NE, email: dirk.claassen{at}elcmht.nhs.uk

Walid K. Fakhoury, Senior Lecturer

Academic Unit, Newham Centre for Mental Health

Richard Ford, Team Manager

Assertive Outreach Team Newham, London

Stefan Priebe, Professor for Social Psychiatry

Queen Mary University, London

Declaration of interest

None.

AIMS AND METHOD

Although financial incentives to improve treatment adherence have been found effective in various medical specialties, there are few systematic data on their use, ethical background and effectiveness in psychiatry. We explored the practice of and possible ethical problems associated with direct financial incentives to improve adherence in assertive outreach teams in England. We also report clinical observations of a money for medication scheme with five assertive outreach patients in East London.

RESULTS

None of the assertive outreach teams that responded to the survey (response rate 47%) uses financial incentives. Attitudes of team managers towards the practice were mostly negative, often regarding it as unethical. Specific concerns were related to possible coercion and a negative impact on the therapeutic relationship. Out of five patients studied, four accepted the offer of money and had improved adherence; three remained without hospital admission since entering the scheme.

CLINICAL IMPLICATIONS

Money for medication might be a non-coercive and effective option to achieve medication adherence in otherwise non-adherent assertive outreach patients. However, ethical issues need further exploration and controlled trials are required to establish the effectiveness.

This article has been cited by other articles:

				T. Burns Is it acceptable for people to be paid to adhere to medication? Yes BMJ, August 4, 2007; 335(7613): 232 - 232. [Full Text] [PDF]

				D. Claassen Financial incentives for antipsychotic depot medication: ethical issues J. Med. Ethics, April 1, 2007; 33(4): 189 - 193. [Abstract] [Full Text] [PDF]

eLetters: