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Coercion has usually been equated with legal detention. Non-statutory pressures to adhere to treatment, 'leverage', have been identified as widespread in US public mental healthcare. It is not clear if this is so outside the USA.To measure rates of different non-statutory pressures in distinct clinical populations in England, to test their associations with patient characteristics and compare them with US rates.Data were collected by a structured interview conducted by independent researchers supplemented by data extraction from case notes.We recruited a sample of 417 participants from four differing clinical populations. Lifetime experience of leverage was reported in 35% of the sample, 63% in substance misusers, 33% and 30% in the psychosis samples and 15% in the non-psychosis sample. Leverage was associated with repeated hospitalisations, substance misuse diagnosis and lower insight as measured by the Insight and Treatment Attitudes Questionnaire. Housing leverage was the most frequent form (24%). Levels were markedly lower than those reported in the USA.Non-statutory pressure to adhere to treatment (leverage) is common in English mental healthcare but has received little clinical or research attention. Urgent attention is needed to understand its variation and place in community practice.

Original publication

DOI

10.1192/bjp.bp.110.086827

Type

Journal article

Journal

The British journal of psychiatry : the journal of mental science

Publication Date

08/2011

Volume

199

Pages

145 - 150

Addresses

Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK. tom.burns@psych.ox.ac.uk

Keywords

Humans, Heroin Dependence, Cross-Sectional Studies, Patient Compliance, Mental Disorders, Psychotic Disorders, Community Mental Health Services, Psychiatric Status Rating Scales, Housing, Cross-Cultural Comparison, Coercion, Adult, Child, United States, England, Female, Male, Statistics as Topic, Surveys and Questionnaires