Mental illness drug payments call

Paying people with severe mental illnesses to take medication may encourage some to stick to their drug regime, a team of London doctors says. They have quoted four cases where payments reportedly increased use of medication and cut hospital admissions.

But campaigners said the Psychiatric Bulletin study did not offer a "real solution" for improving medication use. Between 20% and 50% of adults being treated by psychiatric services are estimated not to take their medication.

It can be very difficult to ensure patients with conditions such as schizophrenia or bipolar disorder take their medication as they should. Particular problems concern patients living in the community - even those under "assertive outreach", where a mental health worker visits patients in their homes.

Previous research has shown that financial incentives helped patients being treated for tuberculosis, dental problems, weight loss and people on cocaine abstinence programmes to stick to their treatment regime.

In this study, the researchers sent questionnaires to the managers of 150 assertive outreach teams, asking if financial incentives were used. None had used financial incentives over the past two years but 10% said they had used food and other indirect incentives to help with "treatment engagement", though not as a direct reward for patients taking their medication.

Three quarters of respondents said they had concerns about using financial incentives, most of whom said the practice would be unethical. Individual managers raised concerns about the possibility patients could be coerced into taking medication, and a negative effect on the relationship between the healthcare worker and the patient. But the researchers also studied five patients who were being treated under the assertive outreach programme in East London from the summer of 2003 onwards.

Each was offered payments of between £5 and £15 per injection of medication. Four accepted, and were found to be more likely to take their drugs as they should and to stay in independent accommodation. They also had fewer problems with the neighbours and the police than before. Three of the four have had no hospital admissions since entering the scheme.

The team, led by Dr Dirk Claassen of East London Community Mental Health Trust, said: "The results in terms of reduced hospital admissions for the patients who accepted the offer seem beneficial. There is no harm intended or caused, the service user can revoke the offer at any time, and the treatment is generally available." He added: "Financial incentives might be a treatment option for a high-risk group of non-adherent patients with whom all other interventions to achieve adherence have failed.

The researchers accept there are a number of practical questions that need to be addressed if this scheme were to become widespread.

However, money for medication may be an effective option to achieve medication adherence in otherwise non-adherent assertive outreach patients.

Mental health charity Rethink chief executive Paul Jenkins told BBC Radio 4's Today programme payments were not a priority for developing services for people with severe mental illness. The key issue was the sometimes "devastating" side-effects of medication, he said. "The research we have done and the calls we get to our advice line report people suffering things like significant weight gain, tiredness, agitation or depression, or physical symptoms like shaking," Mr Jenkins added. "These can affect people's lives very significantly and have a real impact on their ability to keep to taking their medication."

Marjorie Wallace, of the charity Sane, added: "This very small study highlights the desperate situation of people with schizophrenia and bipolar disorder who depend on medication to prevent relapse of their condition. But we believe that offering what amounts to bribes to take medication that can cause serious side effects is no the answer."