BMJ  2007;335:232 (4 August), doi:10.1136/bmj.39286.399514.BE

Feature

Is it acceptable for people to be paid to adhere to medication? Yes

Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX

Plans to give drug users shopping vouchers to attend treatment programmes and stay clean have been unveiled by NICE. Joanne Shaw believes that payment creates perverse incentives, whereas Tom Burns says rewarding patients for cooperation is consistent with good medical practice

The first 150 words of the full text of this article appear below.

How can it be considered perfectly ethical to lock up a patient with psychosis and force them to take drugs against their wishes and yet be "unacceptable" and "unethical"¹ to offer them money to take the same drugs to stay well? Claassen and colleagues offered five assertive outreach patients, with whom they had failed to establish effective maintenance medication, £5-£15 for each injection of depot antipsychotic.¹ Four accepted the offer and have done well; three have stayed out of hospital for two years of follow-up and one improved so much he demanded a pay rise. It doesn't need a health economist to calculate that two years of such payment costs less than a day or two in hospital.

The intense opposition generated by Claassen's report of "money for medicines" should make us think about how we debate the moral problems of modern mental health care. It shows how inadequate our . . . [Full text of this article]

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This article has been cited by other articles:

• Szmukler, G (2009). Financial incentives for patients in the treatment of psychosis. J. Med. Ethics 35: 224-228 [Abstract] [Full text]  
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