Financial incentives to improve adherence to anti-psychotic medication

Adherence to anti-psychotic maintenance medication during the 12-month trial period. Adherence will be measured, objectively, as the percentage of prescribed depot injections actually taken. As the primary outcome, the percentage will be used as a continuous variable. However, we will also analyse the percentage in a dichotomised way, comparing the ratio of patients with 'good' adherence (i.e., greater than or equal to 80% of prescribed depots taken) in the two conditions.

1. The time 'slippage' of taking depots, defined as the percentage of the prescribed time interval that has expired before the depot is taken
2. Clinical improvement as assessed on the Clinical Global Impression Scale (CGI) by the treating consultant psychiatrist at the end of the 12-month period
3. Number of involuntary and voluntary hospital admissions during the trial period
4. Costs of care: data on the use and frequency of use of inpatient care, outpatient care (including home visits, home treatment), and other health services during the 12-month treatment period will be obtained from case notes and electronic administrative data bases. Costs for the intervention will be estimated for each participating team from information provided by staff. Established national unit costs will be used to estimate direct health care.
5. The number of attempted and completed suicides, incidences of physical violence, police arrests and days spent at work/training/education will also be recorded over the 12-month trial period
6. Subjective quality of life and satisfaction with medication which will be assessed at the beginning and end of the intervention period using the 11-item scale established in the DIALOG trial. The scale contains 11 items asking patients to rate their satisfaction with eight life domains and three treatment aspects, one of which is medication, on a scale ranging from 1 (lowest satisfaction) to 7 (highest satisfaction).
7. Continuation with MfM (in intervention group only) and adherence during a 6-month follow up period will be taken from the medical records
8. Teams in the intervention group will be asked after 6 months, 12 months and 18 months about all aspects of experiences with the scheme including whether patients on MfM asked for an increase of the incentive, and whether other patients with hitherto good adherence also asked for financial incentives and/or became poorly adherent in order to be eligible for MfM. This will be done using open questions with a written documentation of the answers.