Token economies

• Outline token economies as used in the management of

  schizophrenia.

  Token economies are reward systems used to manage the behaviour of patients with schizophrenia during their stay in an institution (e.g. hospital).

  The idea is that hospital staff will provide tokens to schizophrenic patients when they have carried out a desirable behaviour.
• Outline token economies as used in the management of

  schizophrenia.

  This is tailored to individual patient’s needs e.g. if they are struggling with avolition, they may be given a token when they make their bed. On the other hand, if they refuse to take their medication due to paranoia, they may be given a token when they take it.

  These tokens can later be swapped for rewards they find motivating such as sweets, magazines etc.
• Outline token economies as used in the management of

  schizophrenia.

  Token economies are therefore a behaviourist way of managing schizophrenia based on operant conditioning.

  Tokens are secondary reinforcers because patients with schizophrenia learn to associate them with rewards (the primary reinforcer).
• Evaluate token economies as used in the management of schizophrenia: easy to implement.

  This is because they do not require a high level of expertise/training and are typically used by existing hospital staff. This is a strength as it enables hospitals to improve the behaviour of many schizophrenic patients in a cost-effective way, thus allowing hospitals to run more smoothly.
• Evaluate token economies as used in the management of schizophrenia: not always easy to carry out.

  This is because there are often issues such as busy hospitals, understaffing or high staff turnover. This is a limitation because it means that token economies are sometimes not consistently implemented which may result in the schizophrenic patients not engaging with the programme.
• Evaluate token economies as used in the management of schizophrenia: little rehabilitative value. 


  This is because the schizophrenic patients may just play along with the system to gain the rewards. This is a limitation because it means that when they return home from hospital, and they are not receiving the rewards anymore, they may revert back to their original behaviour.
• Evaluate token economies as used in the management of schizophrenia: ethically questionable.


  This is because people with less severe symptoms would be able to better engage with the system and access more rewards than people with more severe cases whereby severe avolition would prevent them from displaying the desirable behaviours expected.

  This is a limitation as it means that the most severely ill patients suffer discrimination.