title: Financial incentives for antipsychotic depot medication: ethical issues.
abstract: BACKGROUND
  Giving money as a direct incentive for patients in exchange for depot medication has proved beneficial in some clinical cases in assertive outreach (AO). However, ethical concerns around this practice have been raised, and will be analysed in more detail here.
  
  
  METHODS
  Ethical concern voiced in a survey of all AO teams in England were analysed regarding their content. These were grouped into categories.
  
  
  RESULTS
  53 of 70 team managers mentioned concerns, many of them serious and expressing a negative attitude towards giving money for depot adherence. Four broad categories of ethical concern following Christensen's concept were distinguished: valid consent and refusal (n = 5), psychiatric paternalism (n = 31), resource allocation (n = 4), organisational relationships (n = 2), with a residual category others and unspecified (n = 11).
  
  
  CONCLUSIONS
  The main concerns identified are discussed on the background of existing ethical theories in healthcare and the specific problems of community mental health and AO. Points for practice are derived from this discussion. A way forward is outlined that includes informed consent and an operational policy in the use of incentives, further randomised controlled trials and qualitative studies, and continuing discussions with all stakeholders, especially service users.
authors.affiliation: East London and The City Mental Health Trust, Assertive Outreach Team Newham, 150 Stratford High Street, London E15 2NE, UK. dirk.claassen@elcmht.nhs.uk
authors.forename: Dirk
authors.initials: D
authors.lastname: Claassen
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D003156:Community Mental Health Services / Q000941:ethics* / Q000379:methods; D003692:Delayed-Action Preparations / Q000627:therapeutic use; D004739:England; D006801:Humans; D007258:Informed Consent / Q000941:ethics; D026706:Paternalism / Q000941:ethics; D010349:Patient Compliance / Q000523:psychology*; D026684:Personal Autonomy; D011369:Professional-Patient Relations / Q000941:ethics; D040841:Resource Allocation / Q000941:ethics; D014040:Token Economy
chemical_list: D014150:Antipsychotic Agents; D003692:Delayed-Action Preparations