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Halo

Member
'Pay the sick to take medication'

By PETE BELL
January 03, 2007

The Sun Online

A REPORT written by psychiatrists this morning sparked controversy when it recommended PAYING schizophrenics to take their medication.

The authors of the report said the benefit of adopting such a practice "seemed beneficial" and no harm was "intended or caused".

"Money for medication may be an effective option to achieve medication adherence in otherwise non-adherent assertive outreach patients," the authors wrote.

The report, published in the Psychiatric Bulletin, was co-written by psychiatrists including Dr Dirk Claassen, consultant psychiatrist at the East London and the City Mental Health Trust, and Professor Stefan Priebe, professor of Social Psychiatry at Queen Mary University, London.

It said schizophrenics not taking their medication posed a "major obstacle to effective treatment".

Between 20 per cent and 50 per cent of people in general adult psychiatric services do not take their medication.

This figure was thought to be even higher in areas where patients live in the community and rely on "assertive outreach" services, where patients are visited at home and encouraged to take medication.

As part of the study, five outreach mental health patients in east London with a history of not taking medication were offered between ?5 and ?15 for each treatment, in the form of single depot injections.

Four accepted the deal and managed to continue living independently with fewer problems with police and neighbours.

Three did not need to be re-admitted to hospital while the fourth saw the number of days in hospital drop from 319 in the two years before the scheme to 37 since March 2005.

A questionnaire was also sent to 150 assertive outreach teams asking if they used financial incentives and what they thought of such practices.

Although only 47 per cent responded and none had offered money, 10 per cent said they had used food and other indirect incentives to improve "treatment engagement".

More than three quarters 76 per cent objected to the idea of financial incentives while 42 per cent thought the practice unethical.

Dr Claassen 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.

"Some team managers feared a negative impact on their therapeutic relationships, but the researchers said they did not see this in their clinical practice, and their results in east London are encouraging."

Marjorie Wallace, chief executive of mental health charity SANE, said paying patients to take their medication was equivalent to bribery.

"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 SANE believes that offering what amounts to bribes to take medication that can cause serious side-effects is not the answer."

Ms Wallace said it was more important to identify signs of relapse in a schizophrenic which would imply that medication was not being taken.

"This understanding of their condition, along with counselling and information about their medication provides a more ethical and long-term solution," she added.
 

David Baxter PhD

Late Founder
They are calling it bribery. Interesting, given that it is based solidly on the principles of reinforcement theory and behavior modification.
 

Misha

Member
I still can't help but think that it would be better for many people if they had to pay something for their medications (and other treatments, as well....). Sometimes our health coverage is too good and we become complacent and fall into the system without even realizing it.
The idea of paying is an interesting behavioural concept.... but I think it is the opposite of helpful here.
 

David Baxter PhD

Late Founder
Tbe problem is that individuals suffering from disorders such as schizophrenia and bipolar disorder often don't believe they even need the medication, or that it will help anything. How will making them pay for medications they don't think they need be helpful?
 

Misha

Member
You are (as always....) absolutely right.
I was partially thinking about myself I guess.... it's like how students who pay tuition out of pocket often do better than those with loans, or scholarships for that matter. It makes one evaluate that which they are paying for.
But you are absolutely correct that when the disorder prevents the taking of the medication there needs to be some reinforcer to promote the behavior... but is there another way to reinforce medication-taking behaviour that would train both complaince and, possibly, payment?? I have no idea, just putting it out there.
I have met so many people in hospital who do not want to take their meds when they are psychotic because they feel that the meds are the product of a societal system that has marginalized them and seeks to suppress them. Perhaps the elimination of stigma and a change of societal values is a step in the right direction. (Duh.... but you get my point).
 

David Baxter PhD

Late Founder
I do get your point.

This of course is not a "cure", either. A big part of what I do as a therapist in working with individuals with schizophrenia or bipolar disorder and the like is work on education about medication compliance and the need for/benefits of medication for such disorders. Without that, anything else is pretty much a waste of time. If monetary rewards (or Community Treatment Orders which give the individual a choice between medication or prison for those who have committed crimes) help that process along, everyone benefits - the individual suffering from the illness and the rest of society.

See also [WIKIPEDIA]Kendra's Law[/WIKIPEDIA].
 

Daniel

admin@psychlinks.org
Administrator
If monetary rewards (or Community Treatment Orders which give the individual a choice between medication or prison for those who have committed crimes) help that process along, everyone benefits - the individual suffering from the illness and the rest of society.

I couldn't agree with you more. Ever since a manic relative once threatened my physical safety, I think whatever works is a great idea.
 

Misha

Member
True. I suppose when I get psychotic or manic I too stop taking my meds. Don't you find though that even things like monetary value loses importance to a person when they are in such a state. When I'm out of it, I don't think money would necessarily motivate me any more than anything else... I likely wouldn't see the value in it. If it helps, though, absolutely...
 

Halo

Member
If monetary rewards (or Community Treatment Orders which give the individual a choice between medication or prison for those who have committed crimes) help that process along, everyone benefits - the individual suffering from the illness and the rest of society.

I agree with completely with what David said above. It is like a win/win situation in a way.

When I'm out of it, I don't think money would necessarily motivate me any more than anything else... I likely wouldn't see the value in it.

qmnmd, the portion of your post above made me think that if they are paid to take their medications then the chances of having a manic or psychotic episode and therefore going off their medication and not fully understanding or appreciating the money would be greatly decreased, wouldn't it? Isn't that the whole point of paying them is to prevent them from stopping the medication and having another episode?
 
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Misha

Member
Very true, Nancy. This is starting to look like a good idea after all.
 

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