Structural Leverage in Housing Programs for People with Severe Mental Illness and Its Relationship to Discontinuance of Program Participation

Wong, Yin-Ling Irene; Lee, Sungeun; Solomon, Phyllis

doi:10.1080/15487768.2010.523361

Cited by 5 publications

(5 citation statements)

References 24 publications

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“…The four publications consistently stated that “most” of the professionals used informal coercion in daily routine practice (Table 3). The study investigating housing facilities found that about 60% of malcompliant residents were excluded from the program suggesting a frequent and incisive use of pressure to treatment adherence (24). Professionals intended to foster their patients’ ability to take responsibility for their lives and considered informal coercion as a justifiable method to reach this goal (23).…”

Section: Resultsmentioning

confidence: 99%

Clinical Relevance of Informal Coercion in Psychiatric Treatment—A Systematic Review

Hotzy

Jaeger

2016

Front. Psychiatry

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IntroductionAlthough informal coercion is frequently applied in psychiatry, its use is discussed controversially. This systematic review aimed to summarize literature on attitudes toward informal coercion, its prevalence, and clinical effects.MethodsA systematic search of PubMed, Embase, PsycINF, and Google Scholar was conducted. Publications were included if they reported original data describing patients’ and clinicians’ attitudes toward and prevalence rates or clinical effects of informal coercion.ResultsTwenty-one publications out of a total of 162 articles met the inclusion criteria. Most publications focused on leverage and inducements rather than persuasion and threat. Prevalence rates of informal coercion were 29–59%, comparable on different study sites and in different settings. The majority of mental health professionals as well as one-third to two-third of the psychiatric patients had positive attitudes, even if there was personal experience of informal coercion. We found no study evaluating the clinical effect of informal coercion in an experimental study design.DiscussionCultural and ethical aspects are associated with the attitudes and prevalence rates. The clinical effect of informal coercion remains unclear and further studies are needed to evaluate these interventions and the effect on therapeutic relationship and clinical outcome. It can be hypothesized that informal coercion may lead to better adherence and clinical outcome but also to strains in the therapeutic relationship. It is recommendable to establish structured education about informal coercion and sensitize mental health professionals for its potential for adverse effects in clinical routine practice.

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Section: Resultsmentioning

confidence: 99%

Clinical Relevance of Informal Coercion in Psychiatric Treatment—A Systematic Review

Hotzy

Jaeger

2016

Front. Psychiatry

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“…a payee named by social services to control a patient's financial resources) [6]. Housing is frequently used as a lever for hospital discharge and is considered effective because it reduces hospitalisation and enhances participation in productive life activities [59]. However, housing as a lever has been severely criticised and considered unethical because it denies the patient's civil right to have a house [60].…”

Section: Comparison With the Literaturementioning

confidence: 99%

Persuasion or coercion? An empirical ethics analysis about the use of influence strategies in mental health community care

Valenti

Giacco

2022

BMC Health Serv Res

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Background Influence strategies such as persuasion and interpersonal leverage are used in mental health care to influence patient behaviour and improve treatment adherence. One ethical concern about using such strategies is that they may constitute coercive behaviour ("informal coercion") and negatively impact patient satisfaction and the quality of care. However, some influence strategies may affect patients' perceptions, so an umbrella definition of “informal coercion” may be unsatisfactory. Furthermore, previous research indicates that professionals also perceive dissonance between theoretical explanations of informal coercion and their behaviours in clinical practice. This study analysed mental health professionals’ (MHPs) views and the perceived ethical implications of influence strategies in community care. Methods Qualitative secondary data analysis of a focus group study was used to explore the conflict between theoretical definitions and MHPs’ experiences concerning the coerciveness of influence strategies. Thirty-six focus groups were conducted in the main study, with 227 MHPs from nine countries participating. Results The findings indicate that not all the influence strategies discussed with participants can be defined as “informal coercion”, but they become coercive when they imply the use of a lever, have the format of a conditional offer and when the therapeutic proposal is not a patient’s free choice but is driven by professionals. MHPs are rarely aware of these tensions within their everyday practice; consequently, it is possible that coercive practices are inadvertently being used, with no standard regarding their application. Our findings suggest that levers and the type of leverage used in communications with the patient are also relevant to differentiating leveraged and non-leveraged influence. Conclusion Our findings may help mental health professionals working in community care to identify and discuss influence strategies that may lead to unintended coercive practices.

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“…Older adults with serious mental illness who live independently within the community struggle with symptom control, decreased cognition and physical health (Wong, Lee, & Solomon, 2010).…”

Section: Aging With a Mental Illnessmentioning

confidence: 99%

“…Homeless people living with serious mental illness are less likely to take necessary medications because they do not have funds to obtain them (Wong et al, 2010). Homeless, aging adults with a serious mental illness have decreased cognition and physical health (NCH, 2006).…”

Section: Aging With a Mental Illnessmentioning

confidence: 99%

“…Housing programs offered to individuals with serious mental illness often have rules regarding treatment. However, one study determined that people who were introduced to housing and treatment plans were likely to disregard treatment (Wong et al, 2010). The lack of treatment and medication adherence leaves people living in the community with a serious mental illness at an elevated risk for falling.…”

Section: Aging With a Mental Illnessmentioning

confidence: 99%

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Decreasing Fall Risk in Older Adults with Serious Mental Illness

Hislop²,

Panchasarp³

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The completion of our thesis could not have been made possible without support from each other, our families, the staff and residents at Voyager Carmel, who warmly welcomed us into their community and provided us the opportunity to implement our project, the faculty in the occupational therapy department, and lastly our thesis advisor Dr. Ruth Ramsey. We'd also like to thank our classmates who have helped carry us through this program. The support we have given each other is unrivaled. These past couple years have been a challenging yet fulfilling amazing journey. Thank you so much to all.

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Structural Leverage in Housing Programs for People with Severe Mental Illness and Its Relationship to Discontinuance of Program Participation

Cited by 5 publications

References 24 publications

Clinical Relevance of Informal Coercion in Psychiatric Treatment—A Systematic Review

Clinical Relevance of Informal Coercion in Psychiatric Treatment—A Systematic Review

Persuasion or coercion? An empirical ethics analysis about the use of influence strategies in mental health community care

Decreasing Fall Risk in Older Adults with Serious Mental Illness

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