Acceptability of offering financial incentives to achieve medication adherence in patients with severe mental illness: a focus group study.

BACKGROUND

Offering financial incentives to achieve medication adherence in patients with severe mental illness is controversial.

AIMS

To explore the views of different stakeholders on the ethical acceptability of the practice.

METHOD

Focus group study consisting of 25 groups with different stakeholders.

RESULTS

Eleven themes dominated the discussions and fell into four categories: (1) 'wider concerns', including the value of medication, source of funding, how patients would use the money, and a presumed government agenda behind the idea; (2) 'problems requiring clear policies', comprising of practicalities and assurance that incentives are only one part of a tool kit; (3) 'challenges for research and experience', including effectiveness, the possibility of perverse incentives, and impact on the therapeutic relationship; (4) 'inherent dilemmas' around fairness and potential coercion.

CONCLUSIONS

The use of financial incentives is likely to raise similar concerns in most stakeholders, only some of which can be addressed by empirical research and clear policies.