Paying Patients Improves Mental Health Treatment Engagement

Financial incentives are known to increase patient engagement in a wide range of health programs, including programs for maintaining abstinence from substances, attending vaccination and screening appointments, and increasing physical activity. However, they have rarely been used for mental health care beyond treating substance use disorders.

Showing up and being involved in mental health treatment is half the battle for patients, and our new study, a meta-analysis of existing research, shows that financial incentives can help. The study synthesized findings from 39 papers and found that patients who receive such payments are more likely to attend their mental health treatment, adhere to their medications for mental health disorders, and complete their mental health treatment goals like doing homework.

The effects of the financial incentives were large, with findings suggesting multiple ways in which incentives could be used, such as at the start of treatment to improve attendance for initial sessions, for preliminary treatment goals like signing a treatment plan, and for reducing dropout from psychotherapy, case management, or medication management. Findings also indicated that incentives to enhance treatment engagement might have beneficial downstream effects on mental health symptoms, functioning, and quality of life.

Source: Josh Willink/Pexels

However, efforts to put these findings into practice have run into significant barriers. Some people worry that incentives may coerce patients into seeking treatment or undermine their autonomy, reduce their intrinsic motivation to engage in treatment, or cost too much for the health system to maintain.

Research demonstrates, however, that providers and patients typically value these interventions once they are put into practice, and patients’ intrinsic motivation shows no sign of decreasing after receiving incentives. These financial interventions generally are cost-effective in the long term, particularly when factoring in patients’ potential work productivity or criminal justice costs.

Next Steps

What will it take to move this promising and effective strategy forward? As we discussed in another recent paper, a variety of strategies would help:

• Incentive programs should expand beyond individuals with only substance use disorders to those with other mental health disorders. For example, financial incentives can be used to improve medication adherence among individuals with depression and anxiety.
• Insights from behavioral economics should be used to tailor how incentives are presented to patients and how providers are motivated to implement interventions.
• Corporate partnerships can help overcome financial barriers. These partnerships would decrease implementation costs and connect corporations with members of their communities, allowing their philanthropic contributions to impact patient care directly. Additionally, corporations can use these programs to promote employee mental health by incentivizing outcomes such as mental health treatment attendance, just as many already do to incentivize other healthy behaviors such as exercise.
• Regulatory limits on incentives for patients treated through federally and state-funded programs like Medicaid and Medicare need to be lifted to make the widespread implementation of incentive programs possible. The regulatory landscape is shifting in the right direction, but broad policy modifications are necessary to allow programs offering incentives to be used to their full capacities.
• To further encourage implementation, federally and state-funded programs could provide direct funding for incentives while also enabling oversight of incentive programs to prevent the potential for fraud and abuse that regulatory limits were intended to address.
• Importantly, financial incentives need to be considered alongside other practices that increase access to and engagement in mental health treatment. This includes reducing financial and logistical barriers for patients (e.g., transportation, need for childcare), increasing reimbursement rates for providers through state Medicare programs, and enabling screening and treatment for mental health conditions within more easily accessible settings like primary care.

Research shows that paying patients can significantly improve their engagement in mental health treatment. It is time for practice to catch up with the evidence and payers and providers to utilize financial incentives to improve mental health outcomes.

A version of this post appears on the Leonard Davis Institute of Health Economics website.