Does fear of coercion keep people away from mental health treatment? Evidence from a survey of persons with schizophrenia and mental health professionals

Abstract

Mental health consumer advocates have long argued that involuntary treatment frightens persons with mental disorder and thus deters them from voluntarily seeking help. We surveyed 85 mental health professionals and 104 individuals with schizophrenia spectrum conditions to assess their experience with and perceptions of involuntary treatment and other treatment mandates. Of the clinicians, 78% reported that overall they thought legal pressures made their patients with schizophrenia more likely to stay in treatment. Regarding involuntary outpatient commitment, 81% of clinicians disagreed with the premise that mandated community treatment deters persons with schizophrenia from seeking voluntary treatment in the future. Of the consumer sample, 63% reported a lifetime history of involuntary hospitalization, while 36% reported fear of coerced treatment as a barrier to seeking help for a mental health problem-termed here "mandated treatment-related barriers to care." In bivariate analyses, reluctance to seek outpatient treatment associated with fear of coerced treatment (mandated treatment-related barriers to care) was significantly more likely in subjects with a lifetime history of involuntary hospitalization, criminal court mandates to seek treatment, and representative payeeship. However, experience with involuntary outpatient commitment was not associated with barriers to seeking treatment. Recent reminders or warnings about potential consequences of treatment nonadherence, recent hospitalization, and high levels of perceived coercion generally were also associated with mandated treatment-related barriers to care. In multivariable analyses, only involuntary hospitalization and recent warnings about treatment nonadherence were found to be significantly associated with these barriers. These results suggest that mandated treatment may serve as a barrier to treatment, but that ongoing informal pressures to adhere to treatment may also be important barriers to treatment.

Integrating the criminal justice system into mental health service delivery: the worcester diversion experience

“…It is clear that where prospective patients facing civil commitment are permitted to participate in the decision making process they accept the use of legal commitment if they feel ''that they have been treated with respect, concern, and fairness in the process'' (Lidz et al, 1995;Hiday, Swartz, Swanson, & Wapner, 1997;Poythress, Petrila, McGaha, & Boothroyd, 2002;Bennett et al, 1993;Swartz, Swanson, & Hannon, 2003;Swanson, Swartz, Elbogen, Wapner, & Burns, 2003;Rain, Steadman, & Robbins, 2003;McKenna, Simpson, & Coverdale, 2003;Hoge et al, 1998).…”

Stigma- and non-stigma-related treatment barriers to mental healthcare reported by service users and caregivers

“…These pathways often result in involuntary treatment which is undesirable because it is associated with symptoms of post-traumatic stress disorder through the potential iatrogenic effects of psychiatric care (Tarrier et al, 2007), a reluctance to seek future treatment (Swartz et al, 2003) and higher economic costs (Cheung et al, 2013;Sharac et al, 2010). Consequently, individuals may benefit from an informal caregiver seeking help on their behalf.…”

Prevalence of perceived coercion among psychiatric patients: literature review and meta-regression modelling

“…Published raw prevalence rates of coercion varied from 22% 24 (C. Lidz, coercion data obtained through personal communication, 2011) to 87%. 23 Two papers from an outpatient setting reported raw prevalence rates of 44% 25 and 51%, 26 but they are not included in the subsequent analysis.…”