Perceptions Of Coercion Research Articles

Enhancement of outpatient treatment adherence: Patients' perceptions of coercion, fairness and effectiveness

Interventions aimed at enhancing psychiatric patients' outpatient treatment adherence frequently include informal coercion such as inducements, and threats of negative sanctions. Little is known about patients' subjective perspective concerning these practices. This study examined the perceived coercion, and also the appraisal of the fairness and effectiveness of the treatment. A total of 187 psychiatric patients with different diagnoses were interviewed using a structured questionnaire that included socio-demographic and clinical data, insight into illness (ITAQ), psychopathology (BPRS), functioning (GAF) and a modified version of the MacArthur Admission Experience Survey (AES) as a measure of perceived coercion, fairness and effectiveness. Bivariate correlations and logistic regression analyses were used to identify the influencing factors on the outcome variables. Perceived coercion was associated with experience with informal coercive treatment pressures (OR 2.5–2.9; P < 0.05), and a main diagnosis of a schizophrenic disorder (OR 3.8; P < 0.001). Experience with informal coercion was inversely associated with fairness (OR 0.3–0.4; P < 0.05), but not with effectiveness. Patients with more insight into their illness indicated higher fairness and effectiveness concerning the procedures for enhancing their treatment adherence (OR 3.1; P < 0.01). Insight into illness was not associated with perceived coercion. This might indicate that enhancing insight using psycho-educational approaches and high transparency when applying informal coercive practices could improve patients' appreciation for these procedures. They could probably cope better with perceived coercion when understanding its purpose, and when they perceive they are being treated fairly.

Coercion and Treatment Satisfaction Among Involuntary Patients

Coercion and Treatment Satisfaction Among Involuntary Patients

Coercion and Treatment Satisfaction Among Involuntary Patients

This study aimed to assess involuntary inpatients' satisfaction with treatment and explore how coercion and other factors are associated with satisfaction. An observational prospective study was conducted in 67 acute wards in 22 hospitals in England. A total of 778 involuntary inpatients were recruited, and their satisfaction with treatment was assessed a week after admission and at the one-month, three-month, and one-year follow-ups. Perceived and documented coercion at admission and during hospital treatment, sociodemographic and clinical characteristics, and clinical improvement were tested as potential predictors of satisfaction. Mean scores on the Client's Assessment of Treatment Scale measuring satisfaction with treatment ranged from 5.5 to 6.0 (on a scale with possible scores ranging from 0 to 10) at different time points and improved significantly from admission to the follow-ups. Patients who perceived less coercion at admission and during hospital treatment were more satisfied overall, whereas coercive measures documented in the medical records were not linked to satisfaction. Patients with more symptom improvement expressed higher levels of treatment satisfaction. Satisfaction with treatment among involuntary patients was associated with perceptions of coercion during admission and treatment, rather than with the documented extent of coercive measures. Interventions to reduce patients' perceived coercion might increase overall treatment satisfaction.

Perceived coercion in substance abuse treatment: The eye of the beholder?

Aims: To examine potential differences in subjective perceptions of coercion between substance abuse professionals and clients in how they view events that trigger entry to treatment. Such differences may influence both the clinician's approach and the client's response to treatment.Participants, measurement and findings: Seventy-four substance abuse treatment outpatients and 75 certified substance abuse clinicians rated 15 treatment entry-related events based on the degree of choice an individual would have in entering treatment. Clients perceived internal sources of coercion as more coercive, whereas the clinicians perceived external items as more coercive. Furthermore, clients' views of external coercive events appeared to be more uni-dimensional than for internal events, whereas clinicians perceived internal events as more cohesive relative to external events.Conclusions: Discrepant perceptions of treatment entry triggers may impact the development of a working alliance and the use of motivational strategies intended to enhance readiness to change. Further investigation into these divergent perceptions is needed to untangle the relationships among client and clinician assumptions, readiness for change, and treatment outcome.

Perceptions of Coercion in the Community: A Qualitative Study of Patients in a Danish Assertive Community Treatment Team

Assertive community treatment (ACT) has been claimed to be paternalistic and coercive, yet little is known about how patients experience the assertive aspects of ACT. To explore views on--and perceptions of--coercion of patients in Danish assertive community teams. In-depth interviews were conducted with six purposefully selected patients and analysed using thematic analysis. Patients reported lack of influence on treatment process and a poor alliance with case-mangers, not being recognised as an autonomous person, and experiences of staff crossing the line and intruding privacy, as most central to perceptions of coercion. A collaborative and mutually trusting relationship, commitment, persistence and availability of staff, and recognition of the need for social support and help with everyday activities, were most important for counteracting such experiences. Perceptions of coercion were not emphasised in patients' account of their engagement with ACT, and generally only related to patients' initial contact with ACT staff. The study suggests that developing mental health practices that enhance the formation of a therapeutic relationship with patients will minimize circumstances that induce perceptions of coercion. ACT, with its engaged and committed staff with sufficient time, focusing on social and practical issues, is successful in facilitating such a contact, as experienced by patients.

Techniques Used by Assertive Community Treatment (ACT) Teams to Encourage Adherence: Patient and Staff Perceptions

Assertive community treatment (ACT) has become a cornerstone of care for people with serious mental illnesses. But it has also been suggested that ACT is an inherently coercive approach, with a variety of techniques, including leverage, frequently employed to encourage treatment adherence. Staff and patients of 4 ACT teams participated in focus groups exploring their experiences with and opinions about the use of these techniques in ACT. Little evidence was found of significant use of leverage or perceptions of coercion. Instead both groups reported that supporting patients and building relationships were the preferred mechanisms for promoting treatment goals. This study suggests that ACT need not appear to either staff or patients as an intrinsically coercive model for the delivery of mental health services.

Higher magnitude cash payments improve research follow-up rates without increasing drug use or perceived coercion

In a prior study [Festinger, D.S., Marlowe, D.B., Croft, J.R., Dugosh, K.L., Mastro, N.K., Lee, P.A., DeMatteo, D.S., Patapis, N.S., 2005. Do research payments precipitate drug use or coerce participation? Drug Alcohol Depend. 78 (3) 275–281] we found that neither the mode (cash vs. gift card) nor magnitude ($10, $40, or $70) of research follow-up payments increased rates of new drug use or perceptions of coercion. However, higher payments and payments in cash were associated with better follow-up attendance, reduced tracking efforts, and improved participant satisfaction with the study. The present study extended those findings to higher payment magnitudes. Participants from an urban outpatient substance abuse treatment program were randomly assigned to receive $70, $100, $130, or $160 in either cash or a gift card for completing a follow-up assessment at 6 months post-admission ( n ≅ 50 per cell). Apart from the payment incentives, all participants received a standardized, minimal platform of follow-up efforts. Findings revealed that neither the magnitude nor mode of payment had a significant effect on new drug use or perceived coercion. Consistent with our previous findings, higher payments and cash payments resulted in significantly higher follow-up rates and fewer tracking calls. In addition participants receiving cash vs. gift cards were more likely to use their payments for essential, non-luxury purchases. Follow-up rates for participants receiving cash payments of $100, $130, and $160 approached or exceeded the FDA required minimum of 70% for studies to be considered in evaluations of new medications. This suggests that the use of higher magnitude payments and cash payments may be effective strategies for obtaining more representative follow-up samples without increasing new drug use or perceptions of coercion.

Learning from experiences: quantitative and qualitative analysis of patient experiences during the inpatient admissions process

Objectives The treatment of patients against their will has long been a controversial issue in psychiatric care. Recent research has focused on whether patients perceive they have been coerced into treatment, regardless of whether objectively coercive measures were used. Using both quantitative and qualitative analysis, this study examined perceptions of coercion in a population of patients admitted to psychiatric hospital in the United Kingdom.

Previous Involuntary Commitment is Associated With Current Perceptions of Coercion in Voluntarily Hospitalized Patients

Involuntary psychiatric treatment is sometimes necessary and beneficial, but may also exert negative effects. The impact of involuntary commitment on subsequent mental health treatment experience is poorly understood. We examined whether history of involuntary commitment was associated with current perceptions of coercion in a sample of voluntarily hospitalized veterans (N = 205). In adjusted analyses, perceived coercion during the voluntary admission was significantly associated with prior history of involuntary commitment (Rate Ratio = 1.60, p = .05). Perceived coercion was also higher among participants who were married/cohabiting (Rate Ratio = 1.83, p = .01) and among those with greater functional impairment (Rate Ratio = 0.97, p = .04). Although frequently unavoidable, the current results underscore the potential negative effects of coercive practices such as involuntary commitment, and support the importance of policies that aim to minimize coercive treatment experiences among psychiatric patients.

Applying Procedural Justice Theory to Law Enforcement's Response to Persons With Mental Illness

Applying Procedural Justice Theory to Law Enforcement's Response to Persons With Mental Illness

Perceptions of coercion in the questioning of criminal suspects

AbstractDespite the popular perception that criminal investigations are often solved through the collection of objective or scientific evidence, most cases submitted for prosecution rely on confessions by suspects. Surprisingly, very little is known about which techniques are effective at eliciting admissions from guilty suspects, and in turn, which might be considered to be coercive. In the current study, 200 mock jurors (in Australia) were asked to rate the acceptability of 13 common police interviewing techniques (such as pointing out contradictions, minimisation, silence, etc.). Subjects read one of four versions of a transcript of an interrogation with a suspected sex offender. The transcripts only differed in one detail, the final outcome of the interrogation, with each subject reading one of four different endings (suspect confessed, made a partial admission, denied, or used their right to silence). The results showed that the majority of the strategies were perceived to be coercive, but acceptable. Further, the ‘ends do not justify the means’, in that perceptions of coercion were consistent regardless of the outcome of the interview. The findings are discussed in relation to existing laws and procedures governing police interrogation of suspects, including the ambiguities over the definitions of coercion, oppression, and torture. Copyright © 2008 John Wiley &amp; Sons, Ltd.

Perceived Coercion and Change in Perceived Need for Admission in Patients Hospitalized for Eating Disorders

Objective: Ambivalence toward treatment is characteristic of eating disorders, and patients are often admitted to inpatient programs under pressure from clinicians, family, friends, educators, or employers. This study evaluated patient perceptions of the admissions process and perceived need for hospitalization and assessed whether these perceptions remain stable in the short term. Method: A total of 139 patients with eating disorders completed a 13-item self-report scale on the admission experience when they were admitted to a behavioral inpatient specialty program and again 2 weeks into their hospitalization. Results: Patients with anorexia nervosa reported higher levels of perceived coercion and pressure and a lower sense of procedural justice than did those with bulimia. Patients under 18 (N=35) reported more perceived coercion than did adult patients (N=104), and a trend was noted for them to disagree that they needed hospitalization. Perceptions of coercion, of pressure by others toward hospitalization, and of procedural justice were stable in the short term. However, of the 46 patients (30 of them adults) who initially did not endorse needing admission, 20 patients (17 of them adults) changed their minds by 2 weeks into hospitalization and agreed that they needed hospital admission. Conclusions: Nearly half of patients with eating disorders who denied a need for treatment on admission converted to acknowledging that they needed to be admitted within 2 weeks of hospitalization. Since treatment avoidance is associated with poor outcome, these findings suggest a need for studies assessing the long-term outcome and ethics of pressuring patients with eating disorders into treatment.

Perceived Coercion and Change in Perceived Need for Admission in Patients Hospitalized for Eating Disorders

Ambivalence toward treatment is characteristic of eating disorders, and patients are often admitted to inpatient programs under pressure from clinicians, family, friends, educators, or employers. This study evaluated patient perceptions of the admissions process and perceived need for hospitalization and assessed whether these perceptions remain stable in the short term. A total of 139 patients with eating disorders completed a 13-item self-report scale on the admission experience when they were admitted to a behavioral inpatient specialty program and again 2 weeks into their hospitalization. Patients with anorexia nervosa reported higher levels of perceived coercion and pressure and a lower sense of procedural justice than did those with bulimia. Patients under 18 (N=35) reported more perceived coercion than did adult patients (N=104), and a trend was noted for them to disagree that they needed hospitalization. Perceptions of coercion, of pressure by others toward hospitalization, and of procedural justice were stable in the short term. However, of the 46 patients (30 of them adults) who initially did not endorse needing admission, 20 patients (17 of them adults) changed their minds by 2 weeks into hospitalization and agreed that they needed hospital admission. Nearly half of patients with eating disorders who denied a need for treatment on admission converted to acknowledging that they needed to be admitted within 2 weeks of hospitalization. Since treatment avoidance is associated with poor outcome, these findings suggest a need for studies assessing the long-term outcome and ethics of pressuring patients with eating disorders into treatment.

Development and Investigation of a Free and Informed Choice Process for Embryo Donation to Stem Cell Research in Canada

ObjectivesTo develop and investigate a consent process that satisfies the Assisted Human Reproduction (AHR) Act and the Canadian Institutes of Health Research (CIHR) Stem Cell Guidelines, furthers free and informed choice, and fosters embryo donation to human embryonic stem cell (hESC) research. MethodsConsultations were undertaken with an hESC scientist, in vitro fertilization (IVF) team members, and the ethicist-author of the CIHR Guidelines to review the AHR Act, the CIHR Stem Cell Guidelines, the established consent process for embryo donation at University Hospital, London Health Sciences Centre, the characteristics of patients appropriate for contact, and strategies for sensitive recruitment. Invitation-to-participate packages were sent to patients. ResultsPatients deemed appropriate for contact had indicated their intent to donate embryos to research, had embryos that had been cryopreserved for more than five years, had not received donor gametes, and had publicly listed addresses, with no suggestion of separation of the parties. Strategies developed to promote anonymity, confidentiality, and informed choice included a “firewall” between clinical and research teams and documents reiterating that, if embryos were donated, the woman would have to undergo additional IVF treatment to have a child. Of 40 couples contacted, only 22 agreed to donate embryos to the hESC study. One couple no longer wished to donate embryos to research, one package was returned as undeliverable, and no response was received from 16 couples. ConclusionsThe consent requirements of the AHR Act and the CIHR Stem Cell Guidelines should be met. Consider delaying the request for final consent until a significant time after IVF treatment to ensure that patients no longer want their embryos for reproductive purposes and are free from perceptions of coercion. A consent process promoting free and informed choice, sensitive recruitment, and donation of embryos for hESC research should be developed by the Canadian professional bodies.

The Use of Housing as Leverage to Increase Adherence to Psychiatric Treatment in the Community

For people with mental disorder, access to subsidized housing may be used as "leverage" to obtain adherence to treatment. Interview data from 200 outpatients at each of five sites provided the first national description of the use of housing as leverage. Results indicated that housing is most likely to be used as leverage when it is "special" housing, available only to people with mental illness. Most frequently, respondents state that the requirement that they participate in treatment is imposed by their landlord, rather than by a clinician. The use of housing as leverage strongly increases respondents' perceptions of coercion. Despite this, however, participants who experience housing as leverage are no less satisfied than other participants with the treatment that they receive, and are much more likely than other participants to believe that using housing as leverage is effective in helping people stay well.

Outpatient commitment and coercion in New Zealand: A matched comparison study

Background It has been hypothesized that a degree of coercion is a necessary component in using outpatient commitment to attain therapeutic outcome for those people subject to mental health law. However, what degree of coercion is required and how it is sustained is poorly understood. There is speculation that patients' recognition of beneficial as well as unwanted aspects of outpatient commitment (ambivalence) maybe an indicator that the necessary level of coercion has been achieved to facilitate a therapeutic outcome. Aim The aim of this study was to determine the level of coercion perceived by those under outpatient commitment in New Zealand. Emphasis was given to consideration of the presence of ambivalence and the role of interactive processes, including procedural justice, in influencing patients' perceptions of coercion. Method A cross-sectional comparative study was undertaken to compare the perceptions of coercion of patients on outpatient commitment ( n = 69) to a matched sample of voluntary outpatients ( n = 69), using the Perceived Coercion Scale. The influence of a range of variables, including patients' knowledge of and beliefs concerning outpatient commitment, were considered. Results Although the level of coercion for involuntary outpatients was relatively low, it was significantly higher than that experienced by voluntary outpatients. Yet involuntary outpatients were more likely to espouse benefits of outpatient commitment. Although there was an inverse correlation between perceptions of procedural justice and perceived coercion, procedural justice did not feature in the linear regression analysis. Discussion In the New Zealand context, involuntary outpatients hold contrasting views to outpatient commitment. We suggest that this ambivalence is an indicator that the degree of coercion is suffice to achieve therapeutic outcome. Furthermore, this study suggests the impact of procedural justice on patients' perceptions of coercion may be more crucial during admission to hospital than in the context of on-going community care.

Do research payments precipitate drug use or coerce participation?

Providing high-magnitude cash incentives to substance abuse clients to participate in research is frequently viewed as unethical based on the concerns that this might precipitate new drug use or be perceived as coercive. We randomly assigned consenting drug abuse outpatients to receive payments of $10, $40, or $70 in either cash or gift certificate for attending a 6-month research follow-up assessment. At the 6-month follow-up, participants received their randomly determined incentive and were then scheduled for a second follow-up appointment 3 days later to detect new instances of drug use. Findings indicated that neither the magnitude nor mode of the incentives had a significant effect on rates of new drug use or perceptions of coercion. Consistent with the contingency management literature, higher payments and cash payments were associated with increased follow-up rates. Finally, the results suggest that higher magnitude payments may be more cost-effective by reducing the need for more intensive follow-up efforts.

Patients' perceptions of coercion on admission to forensic psychiatric hospital: a comparison study

Patients' perceptions of coercion on admission to forensic psychiatric hospital: a comparison study

Perceived coercion and treatment adherence in an outpatient commitment program.

The authors investigated whether mental health inpatients' perceptions of coercion were associated with postdischarge treatment adherence. Patients eligible for New York's outpatient commitment program were interviewed and their perceptions of coercion measured during hospitalization and at one, five, and 11 months after discharge. Medication and clinical treatment adherence were measured at the three postdischarge interviews. Among the 117 participants who completed at least one follow-up interview, higher perceived coercion scores were correlated with greater self-reported adherence to clinical treatment at the one-month follow-up but not with participants' greater self-reported adherence at subsequent follow-ups or with providers' ratings of participants' adherence. Perceived coercion scores were positively correlated with participants' self-reported adherence to injected medications.

Perceived coercion at hospital admission and adherence to mental health treatment after discharge.

The authors investigated whether mental health inpatients' perceptions of coercion were associated with later treatment adherence. Psychiatric inpatients receiving acute care at three sites were interviewed during their hospitalization and up to five times after discharge. Patients' perceptions of coercion were measured at admission. Adherence to medication and clinical treatment was measured every ten weeks for one year after discharge. Among the 825 patients who had a perceived coercion score and ten-week follow-up data and who reported that outpatient treatment was prescribed, perceived coercion scores were not associated with treatment adherence. The authors concluded that perceived coercion neither increases nor decreases psychiatric inpatients' medication adherence or use of treatment services after discharge.