An interesting, and controversial, study just popped into my inbox. Researchers at Queen Mary University of London have found that offering £15 to people with severe mental illness in return for them taking antipsychotic medication is an effective way of improving their adherence to treatment.
The study, published in the British Medical Journal, is dealing with an important issue. Non-compliance with antipsychotic medication is linked to, among various things, hospital readmissions as people become unwell and relapse. But the intervention being tested – cash incentives – is controversial. Mental health campaigners have previously warned the practice is coercive and counter to informed decision making.
I’ll lay out the key elements of the latest research below. After you’ve digested it, do leave a comment below on whether you feel financial incentives should be considered or not. The study authors admit this is a controversial practice.
Who took part in the study: 141 patients with a diagnosis of schizophrenia, schizoaffective disorder, or bipolar who had been prescribed long acting antipsychotic injections but had received 75% or less of the injections. The group was split into an ‘intervention group’ of patients who received £15 incentives in return for taking each depot injection and a ‘control group’ who didn’t receive payments.
The results: Average adherence in the ‘intervention group’ rose from an average of 69% to 85% over 12 months in the group that received cash incentives. Average adherence in the ‘control group’ rose from 67% to 71% in the same time period. Some 28% of people in the intervention group had ‘complete adherence’ to treatment during the study. 5% of people in the control group had complete adherence.
“The number of admissions to hospital and adverse events were low in both groups and did not show substantial differences,” the study found.
Implications: Here’s what, Stefan Priebe, Professor of Social Community & Psychiatry at Queen Mary University, had to say:
“Our study concludes offering a modest financial incentive is the most effective method shown so far to improve adherence to antipsychotic treatment. It should be considered if poor treatment adherence poses a risk to patients’ health and if other methods to achieve adherence have failed.
“Whether offering higher financial incentives would be ethically acceptable and more effective remains unclear. Further research is needed to test the longer-term impact of offering financial incentives. In addition, we must continue looking into the psychological mechanisms that can give insight into the positive effects of offering financial incentives – not only on treatment adherence but on subjective quality of life.”
So what do you think? Is this something you’d feel comfortable being offered to people on your caseload who are at risk of relapsing due to non-compliance or is offering cash incentives coercive and unethical? If you receive treatment do you agree with the idea of cash incentives for adherence? Leave comments below.