Do Financial Incentives Increase Mental Health Treatment Engagement? A Meta-Analysis

What is the public health significance of this article? This study shows that it is effective to offer people seeking substance use treatment, and potentially also those seeking treatment for other mental health disorders, financial incentives to encourage them to attend treatment, take medication, and meet treatment goals. Objective: Engagement in mental health treatment is low, which can lead to poor outcomes. We evaluated the efficacy of offering patients financial incentives to increase their mental health treatment engagement, also referred to as contingency management. Method: We meta-analyzed studies offering financial incentives for mental health treatment engagement, including increasing treatment attendance, medication adherence, and treatment goal completion. Analyses were run within a multilevel framework. All study designs were included, and sensitivity analyses were run including only randomized and high-quality studies. Results: About 80% of interventions incentivized treatment for substance use disorders. Financial incentives significantly increased treatment attendance (Hedges' g = 0.49, [0.33, 0.64], k = 30, I-2 = 83.14), medication adherence (Hedges' g = 0.95, [0.47, 1.44], k = 6, I-2 = 87.73), and treatment goal completion (Hedges' g = 0.61, [0.22, 0.99], k = 5, I-2 = 60.55), including completing homework, signing treatment plans, and reducing problematic behavior. Conclusions: Financial incentives increase treatment engagement with medium to large effect sizes. We provide strong evidence for their effectiveness in increasing substance use treatment engagement and preliminary evidence for their effectiveness in increasing treatment engagement for other mental health disorders. Future research should prioritize testing the efficacy of incentivizing treatment engagement for mental health disorders aside from substance use. Research must also identify ways to incentivize treatment engagement that improve functioning and long-term outcomes and address ethical and systemic barriers to implementing these interventions.