Is it acceptable for people to be paid to adhere to medication? Yes

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Abstract
Rewards and coercion already existThe intense opposition generated by Claassen's report of “money for medicines” should make us think about how we debate the moral problems of modern mental health care. It shows how inadequate our current language (locked into oversimplified polarities of “autonomy” and “coercion”) is for this task, and it may have flushed out some overly paternalistic attitudes.There is a body of research investigating patients' experiences of coercion, not just their legal status.2 3 4 More than half of “voluntary” patients don't feel voluntary, and many “involuntary” patients do not feel particularly coerced. Patients acknowledge that our interactions involve a complex trade off between what they want, what their families want, and what doctors want. Choices are constrained—patients may not be legally compelled to go along with us, but neither are they entirely free. Negotiation is a constant reality in mental health care. As for life in general, all relationships imply a constraint, whether imposed by respect, love, family duty, or other.Rewarding patients to cooperate is not new. In a study of over 1000 public mental health patients in the United States, half reported an offer of either coercion (compulsory admission or a jail sentence) or a reward (housing, financial benefits, release from jail) if they adhered to psychiatric treatment.5 Our preliminary work in the United Kingdom found similar rates, although patterns may differ.6Most mental health practitioners reward patients for “healthy” behaviour. Behaviour therapies are based on explicit and consistent rewards; positive therapeutic relationships predict outcomes from dynamic psychotherapies7 to community care of patients with schizophrenia;8 all services emphasise “engagement” and staff prize their skills in achieving it. We are so routinely involved in rewarding and shaping behaviour that we hardly register it.