‘Pay psychiatric patients to take their medication’

GPs are concerned over recent suggestions to offer money to schizophrenia patients in the community to improve their drug adherence.

UK psychiatrists say offering non-adherent patients £5–15 per single depot injection of antipsychotic drugs improves uptake and cuts hospital admissions.  

Out of five schizophrenic patients at the Newham Centre for Mental Health in east London offered the scheme, four agreed.  

As well as improved adherence, they all stayed in their own homes and had fewer problems with neighbours and police than before starting the scheme.  

Since the trial began in summer 2003, three have remained without hospital admission.  

The researchers hope to carry out a randomised controlled trial of the scheme and a study to consider the ethical implications of ‘money for medication’.  

Lead researcher Professor Stefan Priebe, a psychiatrist at Queen Mary University in London, said: ‘There are a small number of patients who would benefit from neuroleptic medication but don’t take it. One would hope that some of them over time would see the benefits, so after a while they wouldn’t have to be paid anymore.’  

At a maximum cost of £25 per month per patient, Professor Priebe argued that the scheme would be cheaper than hospital admission costs.  

Professor Priebe defended the ethical aspects of the scheme saying the motive was rather than threaten patients to offer them a paid reward.  

‘If it is regarded as ethical why shouldn’t it be part of national policy?’, he asked.  

But Dr Huw Lloyd, chairman of the RCGP mental health task group, said: ‘I’m a bit worried about the ethics of it, particularly the impact it has on the doctor– patient relationship.’  

West Midlands GP Dr Ian Walton, chairman of the Primary Care Mental Health and Education group, also had ‘reservations’ about such a scheme.  

‘If you’re not breaking the law, you have the right to refuse medication,’ he said. 

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