Financial incentives and long-acting injectable antipsychotics engagement: community mental health professionals’ perspectives

Long-Acting injectable (LAI) antipsychotics prevent relapse in patients with unreliable adherence to oral antipsychotics. Non-engagement with treatment is associated with relapse and involuntary admission. Financial incentives have been shown to increase engagement with LAI antipsychotics among those at highest risk of relapse. This study aimed to explore whether community mental health professionals who deliver LAI antipsychotics find financial incentives acceptable and whether empirical research has addressed their concerns. Fourteen mental health professionals who deliver LAI antipsychotics were interviewed after snowball recruitment. Each then saw a presentation outlining recent research findings into financial incentives for LAI antipsychotic engagement before interviews resumed. Interviews explored the advantages and challenges professionals anticipated with respect to financial incentives for LAIs. Thematic analysis was conducted and themes were compared with findings from the literature. Median self-reported support increased from "5/10" to "6.75/10" after the information presentation. Participants responded positively to the idea that incentives could be seen as 'rewards'. They readily drew connections between improvements in engagement, increased insight, and stronger therapeutic relationships. Practical implementation challenges were envisioned along with proposed solutions. Several participants remained concerned that financial incentives would lead to increased drug use. Mental health professionals who deliver LAI antipsychotics hold a range of views about the potential role of financial incentives to increase engagement. When professionals are aware of research findings they are more positive about incentives. Further research should consider patients' and professionals' preferences for the design of incentive regimes.