Token Economies as Management

• There is evidence for the limited effectiveness of TEs. McMonagle and Sultana (2009) completed a review of the evidence for TEs and found only 1 of the 3 studies showed improvement in symptoms, and none yielded useful info about behaviour change questioning the effectiveness of TE programmes as a treatment for Scz. This shows TEs don't work for everybody as they didn't actually improve symptoms in the studies assessed. This means that other treatment options must be considered as token economies may discourage patients if they see no improvement in their condition. 
• Ethics issues. TEs are more available to patients with mild symptoms and less those with worse symptoms that give them less desirable behaviour. This is alienating as it punishes more severe Scz's for something not their fault, which makes it less effective as they'll not want to engage with it. This may worsen their mental health by lowering their self-esteem and making them feel guilty. By subjecting the patients to psychological harm, the treatment goes against BPS ethical guidelines as it could worsen the patient’s condition.  
• Psychological therapies aim to make schizophrenia more manageable and improve the patient’s quality of life, they are not a cure. Token economies may improve symptoms short-term but not long-term as it only addresses behaviours and not their or the disorder’s causes. This may mean it is less effective than other options as it cannot be used over a long period of time. 
• TEs' effectiveness is dependent on the person/case. They can be useless if the patient finds no value in the tokens being offered, and they may not work in more severe cases of schizophrenia. TEs may be counterproductive in worse cases as they rely on rewards for desirable behaviours. If a patient is suffering from a severe case of Scz with severe avolition, they may not feel able to demonstrate these desirable behaviours so won’t be given tokens. This could then make them feel hopeless about their condition, worsening their symptoms.