'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.
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.
