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Psychiatric Bulletin (2007) 31: 193. doi: 10.1192/pb.31.5.193a
© 2007 The Royal College of Psychiatrists
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Correspondence

Solmaz Sadaghiani, Senior House Officer in Psychiatry and Chris Fear, Consultant Psychiatrist

Gloucestershire Partnership NHS Trust, Wotton Lawn Hospital, Horton Road, Gloucester GL1 3WL, email: chris.fear{at}glospart.nhs.uk

Claassen et al bring ‘token economies’ into the 21st century through offering financial incentives for single depot injections. The prejudices of the majority of team managers were not explored in detail. Of more interest is the process by which their ‘operational policy’ was developed and its progress through the local research ethics committee. How were the ethical considerations discussed by the authors addressed by the committee?

Two particular concerns arise from this study: the possible unwanted outcomes of payment and the process of discontinuation. The amount of payments ‘depended on the frequency of depot injections’. It is not clear whether more or less frequent injections qualified for higher sums. Differential rewarding might have the unwanted effect of encouraging patients to modify their presentations to maximise payments. There is little possibility of discontinuation while payments are given for adherence and concordance is ignored. Claassen et al comment that adherence achieved through use of financial incentives may lead to greater insight and concordance. In a financially moribund National Health Service, it is likely that the small cost of paying patients to adhere to a treatment plan will obviate the need to provide more costly psychosocial interventions. This would be counterproductive and damaging to the clinical relationship.

Payments tied to a care plan that included psychosocial work with the aim of the patient moving into personally rewarding and possibly paid occupation would avoid problems associated with immediate payment based on adherence to medication. They could also provide an impetus to establishing concordance within a longer-term understanding of the recovery process.





This Article
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Right arrow Submit an eLetter
Right arrow Alert me when this article is cited
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Google Scholar
Right arrow Articles by Sadaghiani, S.
Right arrow Articles by Fear, C.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Sadaghiani, S.
Right arrow Articles by Fear, C.

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