Arash Nakhost1,2, Frank Sirotich3,4, Katherine M Francombe Pridham5, Vicky Stergiopoulos6,7, Alexander I F Simpson8,9. 1. Department of Psychiatry University of Toronto, Toronto, Ontario, Canada. 2. Associate Scientist, Li Ka Shing Knowledge Institute, St Michael Hospital, Toronto, Ontario, Canada. 3. Director of Research and Evaluation, Canadian Mental Health Association (CMHA), Toronto Branch, Toronto, Ontario, Canada. 4. Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada. 5. Centre for Urban Health Solutions, St Michael Hospital, Toronto, Ontario, Canada. 6. Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada. 7. Physician-in-Chief and Clinician Scientist at Centre for Addiction and Mental Health, Toronto, Ontario, Canada. 8. Division of Forensic Psychiatry, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada. 9. Chief of Forensic Psychiatry at the Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
Abstract
OBJECTIVE: Since the deinstitutionalization of psychiatric services around the world, the scope of outpatient psychiatric care has also increased to better support treatment access and adherence. For those with serious mental illness who may lack insight into their own illness, available interventions include coercive community practices such as mandated community treatment orders (CTOs). This paper examines the perceptions of coercion among service users treated with a CTO. METHOD: We used a cross-sectional comparative design where service users treated under a CTO were matched to a comparison group of voluntary psychiatric outpatients. Both groups were receiving intensive community mental health services (n = 69 in each group). Participants were interviewed using a series of questionnaires aimed at evaluating their perceptions of coercion and other aspects of the psychiatric treatment. RESULTS: The level of coercion reported by service users treated under a CTO was significantly higher than that in the comparison group. However, in adjusted analyses, service users' perception of coercion, irrespective of their CTO status, was directly correlated with their previous experience with probation and inversely correlated with the sense of procedural justice in their treatment. CONCLUSIONS: Evaluation of psychiatric service users' experiences of coercion should consider their past and current involvement with other types of coercive measures, particularly history of probation. Clinicians may be able to minimize these experiences of coercion by incorporating procedural justice principles into their practice.
OBJECTIVE: Since the deinstitutionalization of psychiatric services around the world, the scope of outpatient psychiatric care has also increased to better support treatment access and adherence. For those with serious mental illness who may lack insight into their own illness, available interventions include coercive community practices such as mandated community treatment orders (CTOs). This paper examines the perceptions of coercion among service users treated with a CTO. METHOD: We used a cross-sectional comparative design where service users treated under a CTO were matched to a comparison group of voluntary psychiatric outpatients. Both groups were receiving intensive community mental health services (n = 69 in each group). Participants were interviewed using a series of questionnaires aimed at evaluating their perceptions of coercion and other aspects of the psychiatric treatment. RESULTS: The level of coercion reported by service users treated under a CTO was significantly higher than that in the comparison group. However, in adjusted analyses, service users' perception of coercion, irrespective of their CTO status, was directly correlated with their previous experience with probation and inversely correlated with the sense of procedural justice in their treatment. CONCLUSIONS: Evaluation of psychiatric service users' experiences of coercion should consider their past and current involvement with other types of coercive measures, particularly history of probation. Clinicians may be able to minimize these experiences of coercion by incorporating procedural justice principles into their practice.
Entities:
Keywords:
community treatment orders; perceived coercion; procedural justice
Authors: Richard A Van Dorn; Jeffrey W Swanson; Marvin S Swartz; Christine M Wilder; Lorna L Moser; Allison R Gilbert; Andrew M Cislo; Pamela Clark Robbins Journal: Psychiatr Serv Date: 2010-10 Impact factor: 3.084