Paying patients with psychosis to improve adherence

Poor adherence to treatment is a problem across the whole of medicine, with people not attending appointments, not taking their drugs as prescribed, or not taking them at all. More than 50% of people with schizophrenia have been estimated not to adhere to prescribed drugs,1 leading to higher rates of relapse and hospital admission, as well as increased costs.2 3 Attempts to improve adherence in this population using interventions such as “compliance/adherence therapy,”4 along with the development of long acting depot antipsychotics, have not produced the expected benefits. In a linked paper (doi:10.1136/bmj.f5847), Priebe and colleagues found that modest financial incentives significantly improved adherence in people treated with depot drugs for schizophrenia and other psychoses in the United Kingdom.5

It is difficult to achieve adherence to antipsychotic drugs in people with psychoses for several reasons. Many do not accept that they are ill so do not believe that they need treatment. Antipsychotics are associated with serious side effects including diabetes, obesity, and neurological problems, especially if used at higher doses. Although other effective treatments …