Token economy systems: breakdown and control

Attention is drawn to the relatively high rate of breakdown of token economy programmes, and the reasons for this are considered. Reference is made to the results of a questionnaire circulated to British token economy programmes. Reasons for breakdown are considered in five categories, these being: nonexistent or poor patient selection; inadequate selection and training of nursing and ward staff; lack of definition of the functions of the supervising psychologist; poor co-operation from, and communication with, administrative staff; and active interference by the community. Solutions to these problems are suggested. The value of alternative or additional theoretical frameworks in promoting positive control of token systems is discussed.