‘When coercion moves into your home’ - a qualitative study of patient experiences with outpatient commitment in Norway

Abstract

The use of coercion on people with mental health problems is a serious intervention, and a reduction in its use is a declared goal in mental healthcare. Yet, many countries have introduced expanded powers of coercion in recent years, including outpatient commitment (OC). However, the evidence of the effectiveness of OC is inconclusive, and little is known about how patients experience OC schemes. The objective of this qualitative study was to explore (i) patients' experiences with OC, and (ii) how routines in care and health services affect patients' everyday living. The data were collected in 2011-2012 and included 11 qualitative in-depth interviews with patients subject to OC. The study used a narrative approach to interviews and a thematic narrative analysis. Participants generally complied with the OC requirements because of the clear and secure framework of OC, and also because they believed that the alternative would be involuntary hospitalisation. No one reported physical force, but coercion was experienced as limitation of freedom of action through excessive control and little patient influence or participation in their own treatment. Factors affecting patients' freedom of action under OC should be taken into account when the imposition of an OC order is considered.