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Published Online: 1 October 2015

Perception of Coercion Among Patients With a Psychiatric Community Treatment Order: A Literature Review

Katherine M. Francombe Pridham, M.S.W., Andrea Berntson, M.D., Alexander I. F. Simpson, M.B.Ch.B., B.Med.Sci., Samuel F. Law, M.D., Vicky Stergiopoulos, M.D., M.H.Sc., and Arash Nakhost, M.D., Ph.D.Authors Info & Affiliations
Publication: Psychiatric Services
Volume 67, Number 1
https://doi.org/10.1176/appi.ps.201400538
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Abstract

Objective:

Various forms of compulsory psychiatric community treatment orders (CTOs) are commonly utilized internationally. CTOs remain contentious because of the ethical implications of coercing patients to receive treatment. Understanding patients’ experience of CTOs can assist in the development of more patient-centered and recovery-focused community care. This review examined the relationship between CTOs and patients’ perceptions of coercion in the literature.

Methods:

A search of key terms relating to CTOs and patients’ perceptions of coercion was conducted of relevant databases from their inception to March 31, 2014. Publications were included if they were peer reviewed, reported on original research, surveyed or interviewed patients who were or had been subject to a CTO, and were written in English. Factors influencing patients’ perceptions of coercion, including the regional context of the studies, were identified.

Results:

Twenty-three primary research articles, reporting on 14 studies from seven countries, were included. Evidence indicated that CTOs may contribute to a patient’s sense of coercion, with marked variations among studies in the levels of coercion. Contextual factors, including perceptions of alternatives to CTOs, the presence of additional forms of leverage in patients’ lives, and the process of CTO initiation and enforcement, may mitigate or enhance perceptions of coercion.

Conclusions:

Coercive elements of CTOs may be reduced through increased patient access to information, better working relationships with service providers, and accessible, fair processes. The coercive aspects of CTOs should be seen as part of a broader understanding of the daily pressures and leverage applied in outpatient psychiatric treatment.

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Information & Authors

Information

Published In

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Cover: Landscape, by Louis Comfort Tiffany, ca. 1892. Stained glass. Private Collection. Photo credit: Art Resource, New York City.

Psychiatric Services
Volume 67 • Number 1 • January 01, 2016
Pages: 16 - 28
PubMed: 26423101

History

Received: 24 November 2014
Revision received: 3 April 2015
Accepted: 11 May 2015
Published online: 1 October 2015
Published in print: January 01, 2016

Authors

Details

Katherine M. Francombe Pridham, M.S.W.
Ms. Francombe Pridham, Dr. Law, Dr. Stergiopoulos, and Dr. Nakhost are with the Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada, and Dr. Law, Dr. Stergiopoulos, and Dr. Nakhost are also with the Department of Psychiatry, University of Toronto, also in Toronto, where Dr. Berntson and Dr. Simpson are affiliated (e-mail: [email protected]). Dr. Berntson is also with the Department of Psychiatry, Mount Sinai Hospital, and Dr. Simpson is also with the Centre for Addiction and Mental Health, both in Toronto.
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Andrea Berntson, M.D.
Ms. Francombe Pridham, Dr. Law, Dr. Stergiopoulos, and Dr. Nakhost are with the Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada, and Dr. Law, Dr. Stergiopoulos, and Dr. Nakhost are also with the Department of Psychiatry, University of Toronto, also in Toronto, where Dr. Berntson and Dr. Simpson are affiliated (e-mail: [email protected]). Dr. Berntson is also with the Department of Psychiatry, Mount Sinai Hospital, and Dr. Simpson is also with the Centre for Addiction and Mental Health, both in Toronto.
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Alexander I. F. Simpson, M.B.Ch.B., B.Med.Sci.
Ms. Francombe Pridham, Dr. Law, Dr. Stergiopoulos, and Dr. Nakhost are with the Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada, and Dr. Law, Dr. Stergiopoulos, and Dr. Nakhost are also with the Department of Psychiatry, University of Toronto, also in Toronto, where Dr. Berntson and Dr. Simpson are affiliated (e-mail: [email protected]). Dr. Berntson is also with the Department of Psychiatry, Mount Sinai Hospital, and Dr. Simpson is also with the Centre for Addiction and Mental Health, both in Toronto.
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Samuel F. Law, M.D.
Ms. Francombe Pridham, Dr. Law, Dr. Stergiopoulos, and Dr. Nakhost are with the Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada, and Dr. Law, Dr. Stergiopoulos, and Dr. Nakhost are also with the Department of Psychiatry, University of Toronto, also in Toronto, where Dr. Berntson and Dr. Simpson are affiliated (e-mail: [email protected]). Dr. Berntson is also with the Department of Psychiatry, Mount Sinai Hospital, and Dr. Simpson is also with the Centre for Addiction and Mental Health, both in Toronto.
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Vicky Stergiopoulos, M.D., M.H.Sc.
Ms. Francombe Pridham, Dr. Law, Dr. Stergiopoulos, and Dr. Nakhost are with the Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada, and Dr. Law, Dr. Stergiopoulos, and Dr. Nakhost are also with the Department of Psychiatry, University of Toronto, also in Toronto, where Dr. Berntson and Dr. Simpson are affiliated (e-mail: [email protected]). Dr. Berntson is also with the Department of Psychiatry, Mount Sinai Hospital, and Dr. Simpson is also with the Centre for Addiction and Mental Health, both in Toronto.
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Arash Nakhost, M.D., Ph.D.
Ms. Francombe Pridham, Dr. Law, Dr. Stergiopoulos, and Dr. Nakhost are with the Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada, and Dr. Law, Dr. Stergiopoulos, and Dr. Nakhost are also with the Department of Psychiatry, University of Toronto, also in Toronto, where Dr. Berntson and Dr. Simpson are affiliated (e-mail: [email protected]). Dr. Berntson is also with the Department of Psychiatry, Mount Sinai Hospital, and Dr. Simpson is also with the Centre for Addiction and Mental Health, both in Toronto.
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Notes

A poster presenting preliminary results of this review was presented at the Institute on Psychiatric Services, San Francisco, October 29–November 2, 2014.

Competing Interests

The authors report no financial relationships with commercial interests.

Funding Information

St. Michael's Hospital, Toronto, Canada
This research was financially supported by the Psychiatric Associates of St. Michael’s Hospital, Toronto, Ontario, Canada.

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