Do financial incentives increase treatment adherence in people with severe mental illness? A systematic review

Abstract

SUMMARY Aim – To identify whether financial or material incentives improve treatment adherence in people with severe mental illness. Method – A systematic review of studies published between 1950 and 2008 was conducted. EMBASE, MEDLINE, EBM, AMED and PsycINFO were searched. Studies were included if a financial or material incentive was offered and if the sample had a severe mental illness. Results – Fourteen articles were identified; three studies on adherence to psychiatric treatment and one on physical exercise. Ten articles used incentives for adherence to substance misuse treatment programmes. In all studies, financial incentives were associated with an increase in adherence; however the effect was not always maintained once the incentive was withdrawn. Conclusion – While existing research suggests that financial incentives may improve treatment adherence in severely mentally ill populations, very few studies focus on psychiatric treatment. Further research may address the long term effectiveness of incentives on adherence in this population. Declaration of Interest: The authors on this paper were supported by funds from the Wellcome Trust. All authors worked on a Wellcome Trust funded qualitative focus group study exploring stakeholder views on offering patients financial incentives to adhere to antipsychotic medication. Priebe is also lead applicant on a National Institute of Health Research (England) (NIHR) awarded grant to conduct a clinical trial on the use of financial incentives to achieve maintenance antipsychotic medication adherence.