Mentally ill patients offered cash incentive to take drugs

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Indy Lifestyle Online

Mentally ill patients are being paid by the NHS to take their drugs in a radical experiment to improve compliance.

Four patients suffering from schizophrenia are receiving between £5 and £15 each time they have a "depot" injection - a long acting drug which is normally given once a month.

The payments handed out by the Newham Centre for Mental Health in east London have dramatically improved the patients' adherence to treatment and reduced the time they spend in hospital suffering relapses, and problems with neighbours and the police.

But the scheme has been attacked by mental health managers who say it is unethical, coercive and could have a negative effect on the therapeutic relationship.

Persuading mentally ill patients to take their drugs is one of the big challenges in psychiatry, with non-adherence rates ranging from 20 to 50 per cent. Many of the inquiries into killings by people with mental illness have shown that the crime happened after they stopped taking their drugs.

In the US, financial incentives have been used to persuade other types of patient to take regular treatment, specially where it has unpleasant side effects or involves pain or effort. Findings from 10 of 11 studies found offering payments from $5 (£2.50) to $1,000 produced favourable results.

In the first British study, published in the Psychiatric Bulletin, Dirk Claassen, a former consultant psychiatrist at the East London and City Mental Health Trust, and Stefan Priebe, professor of social psychiatry at Queen Mary, University of London, say their findings are also "rather encouraging".

The four patients in the study were cared for by an assertive outreach team and had a history of stopping their medication and getting into trouble. That changed when they were paid, with three of the four needing no hospital admissions, compared with between 80 and 362 days in the previous two years.

However, a survey of 150 team managers of assertive outreach teams revealed widespread distaste for the approach. Three-quarters said they objected to payments on ethical grounds - some objected because of the impact on NHS budgets.

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