Experienced Coercion Research Articles

Pathways to experienced coercion during psychiatric admission: a network analysis

BackgroundIn mental health care, experienced coercion, also known as perceived coercion, is defined as the patient’s subjective experience of being submitted to coercion. Besides formal coercion, many other factors have been identified as potentially affecting the experience of being coerced. This study aimed to explore the interplay between these factors and to provide new insights into how they lead to experienced coercion.MethodsCross-sectional network analysis was performed on data collected from 225 patients admitted to six psychiatric hospitals. Thirteen variables were selected and included in the analyses. A Gaussian Graphical Model (GGM) using Spearman’s rank-correlation method and EBICglasso regularisation was estimated. Centrality indices of strength and expected influence were computed. To evaluate the robustness of the estimated parameters, both edge-weight accuracy and centrality stability were investigated.ResultsThe estimated network was densely connected. Formal coercion was only weakly associated with both experienced coercion at admission and during hospital stay. Experienced coercion at admission was most strongly associated with the patients’ perceived level of implication in the decision-making process. Experienced humiliation and coercion during hospital stay, the most central node in the network, was found to be most strongly related to the interpersonal separation that patients perceived from staff, the level of coercion perceived upon admission and their satisfaction with the decision taken and the level of information received.ConclusionsReducing formal coercion may not be sufficient to effectively reduce patients’ feeling of being coerced. Different factors seemed indeed to come into play and affect experienced coercion at different stages of the hospitalisation process. Interventions aimed at reducing experienced coercion and its negative effects should take these stage-specific elements into account and propose tailored strategies to address them.

Effect of standardized post-coercion review on subjective coercion: Results of a randomized-controlled trial.

Post-coercion review has been increasingly regarded as a useful intervention in psychiatric inpatient setting. However, little is known about its effect on perceived coercion. A multicenter, two-armed, randomized controlled trial was conducted, aiming at analyzing the effect of post-coercion review on perceived coercion. People with severe mental disorders, who experienced at least one coercive measure during inpatient treatment, were randomized using Zelen's design to an intervention group receiving standardized post-coercion review, or a control group treated as usual. The MacArthur admission experience scale (AES) and the coercion ladder (CL) were used to assess perceived coercion during inpatient treatment. The coercion experience scale (CES) measured experienced coercion during the coercive intervention. Analyses of covariance were performed to determine group differences. Of 422 randomized participants, n=109 consented to participate in the trial. A restricted intention-to-treat analysis of all individuals who consented revealed no significant effect of the intervention on perceived coercion. A significant interaction effect between the factors gender and intervention on the AES scores was found. Sensitivity analysis revealed significant effects of the intervention on both AES and CL scores and an interaction effect between intervention and gender, indicating a higher efficacy in women. No effect of the intervention on CES scores was found. Standardized post-coercion review sessions did not alleviate the subjective perception of coercion in the total sample. However, post hoc analysis revealed a significant effect of the intervention in women. Results indicate the need to further address gender-specific issues related to coercion.

Authoritarianism and Social Policy

Authoritarianism seems to be emerging as the default mode of global capitalism. In the absence of reliable economic growth, and with working-class incomes in long-term stagnation, both liberal and social democratic parties have lost support in many countries, and authoritarian regimes have come to power in several. But poor people in the USA, UK and Europe have long experienced coercion, being forced to accept low-paid, insecure work or face benefits sanctions. As a growing proportion of workers have come to rely on supplements such as tax credits, the working class has been divided, and opportunistic authoritarian politicians have mobilised the anxiety and resentment of those on the margins of poverty. This article argues that only an active civil society, with voluntary agencies uncompromised by involvement in coercive policies, along with universal, unconditional Basic Incomes for all citizens, can reverse these trends.

A cross-sectional study of experienced coercion in adolescent mental health inpatients

BackgroundInvoluntary care and coercive measures are frequently present in mental healthcare for adolescents. The purpose of this study was to examine to what extent adolescents perceive or experience coercion during inpatient mental health care, and to examine predictors of experienced coercion.MethodsA cross-sectional sample of 96 adolescent inpatients from 10 Norwegian acute and combined (acute and sub-acute) psychiatric wards reported their experienced coercion on Coercion Ladder and the Experienced Coercion Scale in questionnaires. Staff reported use of formal coercion, diagnoses, and psychosocial functioning. We used two tailed t-tests and mixed effects models to analyze the impact from demographics, alliance with parents, use of formal coercion, diagnostic condition, and global psychosocial functioning.ResultsHigh experienced coercion was reported by a third of all patients. In a mixed effects model, being under formal coercion (involuntary admission and / or coercive measures); a worse relationship between patient and parent; and lower psychosocial functioning, significantly predicted higher experienced coercion. Twenty-eight percent of the total sample of patients reported a lack of confidence and trust both in parents and staff.ConclusionsRoughly one third of patients in the sample reported high experienced coercion. Being under formal coercion was the strongest predictor. The average scores of experienced coercion in subgroups are comparable with adult scores in similar care situations. There was one exception: Adolescents with psychosis reported low experienced coercion and almost all of them were under voluntary care.

The development, validation, and feasibility of the Experienced Coercion Scale.

Existing scales for experienced coercion have limitations. We developed and validated a short self-report form for experienced coercion for use across care settings, care phases, and care measures. In Stage 1, we developed an item pool, based on the literature, patient accounts, interviews, and expert feedback. Stages 2 and 3 consisted of 2 cross-sectional studies, with patients from acute and nonacute inpatient wards, outpatient care, and supported housing. In Stage 2, patients (N = 212) responded to the Coercion Ladder and the experienced coercion items from Stage 1. We selected 20 items for Stage 3 based on item performance in typically coercive versus voluntary care settings, each items' relation to the Coercion Ladder score, and with regard to the component structure from principal component analysis (PCA). In Stage 3, we collected and examined item responses and clinical and coercion data from a new sample of patients (N = 219). We selected 15 items based on factor loadings to form part of the final Experienced Coercion Scale (ECS). The internal consistency was high and score distribution approached the normal curve. ECS sum scores correlated strongly with scores on the Coercion Ladder. In a regression analysis, demographic variables, diagnosis, duration of treatment, and care setting did not predict ECS scores, while legal status and continuing involuntary medication significantly predicted scores. In this initial study, the ECS scores showed promising psychometric properties, suggesting it can be used across care settings and is suitable for research and service evaluation. (PsycINFO Database Record

Coercion, competence, and consent in offenders with personality disorder

ABSTRACTCompetence to consent to treatment has not previously been examined in a personality disorder cohort without comorbid mental disorder. We examined competence and coercion in 174 individuals diagnosed with severe personality disorder using two validated tools (the MacArthur Competence Assessment Tool for Treatment and the MacArthur Coercion Assessment Scale – Short Form). Competence was not categorically impaired, but there were variations within the sample on dimensional competence measures. Further, there were significant negative correlations between experienced coercion and competence. Higher coercion scores were associated with two components of competence: lower understanding and reasoning. Patients who consented to treatment had higher scores on competence measures and experienced less coercion. These findings suggest that therapeutic approaches that decrease experienced coercion and increase competence may increase the engagement of individuals diagnosed with severe personality disorders in treatment.

Psychiatric advance directives, a possible way to overcome coercion and promote empowerment.

Psychiatric advance directives (ADs) allow an individual to state their preferences for future treatment at times when they may be unable to make considered decisions. There are differences in their form and legal value and the process associated with their use and completion. Several studies have now been completed to assess the impact of ADs on service use and coercion. Their results give a mixed picture but directives nevertheless have the potential to support the empowerment process, minimize experienced coercion, and improve coping strategies. These may in turn reduce the frequency of in-patient service use. Further studies on the different processes of facilitation involved and on different populations are necessary to improve our knowledge and use of these potentially powerful interventions.

Actor-partner effects associated with experiencing intimate partner violence or coercion among male couples enrolled in an HIV prevention trial

BackgroundIntimate partner violence (IPV) and coercion have been associated with negative health outcomes, including increased HIV risk behaviors, among men who have sex with men (MSM). This is the first study to describe the prevalence and factors associated with experiencing IPV or coercion among US MSM dyads using the actor-partner interdependence model (APIM), an analytic framework to describe interdependent outcomes within dyads.MethodsAmong MSM couples enrolled as dyads in an HIV prevention randomized controlled trial (RCT), two outcomes are examined in this cross-sectional analysis: 1) the actor experiencing physical or sexual IPV from the study partner in the past 3-months and 2) the actor feeling coerced to participate in the RCT by the study partner. Two multilevel APIM logistic regression models evaluated the association between each outcome and actor, partner, and dyad-level factors.ResultsOf 190 individuals (95 MSM couples), 14 reported experiencing physical or sexual IPV from their study partner in the past 3 months (7.3%) and 12 reported feeling coerced to participate in the RCT by their study partner (6.3%). Results of multivariate APIM analyses indicated that reporting experienced IPV was associated (p < 0.1) with non-Black/African American actor race, lower actor education, and lower partner education. Reporting experienced coercion was associated (p < 0.1) with younger actor age and lower partner education.ConclusionsThese findings from an HIV prevention RCT for MSM show considerable levels of IPV experienced in the past 3-months and coercion to participate in the research study, indicating the need for screening tools and support services for these behaviors. The identification of factors associated with IPV and coercion demonstrate the importance of considering actor and partner effects, as well as dyadic-level effects, to improve development of screening tools and support services for these outcomes.

Coercion in a locked psychiatric ward

In spite of a national strategy for reducing coercion in the mental health services, Norway still has a high rate of involuntary treatment compared to other European countries. It is therefore crucial to study various parties involved in involuntary treatment in order to reduce coercion. How do patients and staff in a Norwegian locked psychiatric ward experience coercion? Participant observation and interviews. A total of 12 patients and 22 employees participated in this study. This study is accepted by the National Committee for Medical Health Research Ethics. The participants experienced coercion in different ways. Patients often felt inferior, while many of the staff felt guilty for violating patients' dignity, although they ascribed responsibility for their actions to the "system." The main themes are (1) corrections and house rules, (2) coercion is perceived as necessary, (3) the significance of material surroundings, and (4) being treated as a human being. The discussion draws upon the concepts of vulnerability, guilty conscience, and ethical sensitivity, related to the staffs' divergent views on coercion. Especially among staff, there are divergent views of coercion. Professionals being physically and emotionally close to the patient are more likely to understand him or her as a unique person with individual needs. If patients are kept at a distance, professionals as a group change to understand patients as members of a group with common needs and common restrictions.

Law &amp; Psychiatry: Deception, Coercion, and the Limits of Interrogation

This column discusses the recent case of U.S. v. Boskic to highlight issues related to voluntariness--in particular, the voluntariness of a confession. At a meeting with U.S. government agents, Boskic, a Croat from Bosnia living in the United States, confessed to involvement in the 1995 Srebrenica massacre. The agents had deceived him about the meeting's purpose and did not disclose that they had a warrant for his arrest. The courts were asked to decide whether the confession was involuntary, and thus not admissible as evidence, on the basis of whether the deception was coercive.

Patients’ perception of coercion in acute psychiatric wards. An intervention study

A project based on the “Breakthrough series” for reducing the patients’ perception of coercion in psychiatric acute wards is presented. Three different measures were chosen: 1) engagement of the patients in the formulation of the treatment plan, 2) frequent and regular joint patient and staff evaluations, and 3) renegotiation of treatment plans if necessary. A 5-week baseline was followed by a 12-week intervention period. Anonymously administered self-rating scales were used: the Coercion Ladder and the SPRI questionnaire. Two questions addressing aversive events (verbal and physical) were added. Participation rates were 86% (patients). Data from 190 admissions were analysed. The interventions resulted in only marginal changes in two of eight parameters (the staff's respect and understanding and on total satisfaction with the received help) and no change in experienced coercion. Seclusion accounted for 46% of the explained variance (62%) and participation in the formulation of the treatment plan for only 8% in regression analyses where perceived coercion was the dependent variable; a third of the patients had experienced insulting communication from the staff, and 10% physical harassment during their stay. It was concluded that: 1) the average value of experienced coercion was low, 2) taking part in the planning and evaluation of the treatment had marginal effect on experienced coercion, and 3) the main predictor of felt coercion was seclusion. Actions taken primarily to control behaviour were more strongly related to perceived coercion than aspects of compulsory treatment. More thorough analysis of seclusion and improved routines for its implementation are needed.

Pet Abuse by Batterers as a Means of Coercing Battered Women Into Committing Illegal Behavior

Threats to harm and actual harm/killing of animals were explored in a group of emotionally and physically abused women evaluated at a family violence center. Each of the 107 women studied had committed at least one illegal behavior. Seventy-two of the 107 women had owned pets, either during the last year or currently (62%). Fifty-four of the 72 women owning pets reported actual and threatened pet abuse (75%). In all cases, there was at least one reported incident of physical abuse to the pet. Among these 54 women, 24 experienced coercion in the form of threats, and in each case, at least one incident of actual harm to animals occurred in order to force the women to commit an illegal act(s) (44%). Among these 24 coerced women, nine of them described threats of and actual abuse to pets in the context of coercion without threats to other loved ones such as children and elderly parents (38%). Each of the 24 coerced women reported committing the illegal act(s) to spare her pet the experience of abuse. They all reported a sense of desperation and anguish at having to violate their own value systems and become victim-perpetrators, or victims who perpetrated crimes.