Informal coercion

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In the context of a doctor–patient relationship, Informal coercion is a social process where a healthcare profession tries to make a patient adhere to the healthcare systems desired treatment without making use of formal coercion such as involuntary commitment combined with involuntary treatment.[1]: 18  An example of involuntary treatment is intramuscular injection with haloperidol.[2]: 60 

Informal coercion is often applied by health professionals as part of mental health treatment but is also used by friends and family of a service user.[1]: 26 

Classification

Several hierarchies of informal coercion have been created.Smuzkler and Appelbaum defined a five-level hierarchy of coercion:[1]: 19 [3]: 96 

  1. persuasion
  2. Interpersonal leverage
  3. inducements
  4. threats
  5. compulsory treatment

Lidz et all define nine forms of informal coercion:

  1. persuasion
  2. inducement
  3. threats,
  4. show of force
  5. physical force
  6. legal force
  7. request for a dispositional preference
  8. giving orders
  9. deception.

Interpersonal leverage

If the service user has an emotional dependency on the service provider. The clinician can use displays of disappointment to influence the service user.[1]: 19 

Inducements

The patient may be demanded to do what a clinician wants to secure access to goods of monetary value such as housing, money, children, and criminal justice.[1]: 19  Conditional access to housing is the most common form of inducement in informal coercian, being report by 15-40% of service users.[1]: 26  A study of informal coercion in housing provision found that 60% of noncompliant service users were excluded from the program.[1]: 20 

Healthcare worker may use inducements such as cigarettes, drinks of a walk to persuade patients to take their medication.[4]: 2 

Threats

The threat of involuntary commitment or involuntary treatment of treatment may be used to convince patients to comply without using formal coercion.[4]: 2 

Prevalence

Studies show that most mental heatlh professionals use informal coercion in daily routine practice.[1] : 20 

Practictioners use informal coercion more than they are aware, and a study showed its is underestimated.[1]: 26  29-59% of service users in studies in different regions report informal coercion.[1]: 18  Judicial leverage, where a service user complies to avoid legal proceedings was reported by 11-23% of service users.[1]: 26 

Attitudes amongst service users

55-69% of service users said they perceived interpersonal leverage as fair and 48-60% as effective. Studies show that patients with higher insight were more favourable to coercion. Patients diagnosed with schizophrenia are more likely to say that informal coercion is taking place, and are more negative about coercion.[1]: 26 

Attitudes amongst service providers

Service providers consider informal coercion as a means to promote compliance, which they felt could prevent worsening of symptoms and the need for formal coercion. Professionals felt that informal coercion could encourage individuals to take more agency over their lives.[1]: 20, 26 

References

  1. 1 2 3 4 5 6 7 8 9 10 11 12 13 Hotzy, Florian; Jaeger, Matthias (2016). "Clinical Relevance of Informal Coercion in Psychiatric Treatment—A Systematic Review" (PDF). Frontiers in Psychiatry. 7: 197. doi:10.3389/fpsyt.2016.00197. ISSN 1664-0640.
  2. ↑ Violence and aggression: short-term management in mental health, health and community settings: NICE guideline. National Institute of Clinical Excellence. 2015.
  3. ↑ Coercion in community mental health care : international perspectives. Andrew Molodynski, Jorun Rugkåsa, Tom Burns. Oxford. 2016. ISBN 978-0-19-103431-2. OCLC 953456448.{{cite book}}: CS1 maint: others (link)
  4. 1 2 Pelto-Piri, Veikko; Kjellin, Lars; Hylén, Ulrika; Valenti, Emanuele; Priebe, Stefan (December 2019). "Different forms of informal coercion in psychiatry: a qualitative study" (PDF). BMC Research Notes. 12 (1): 787. doi:10.1186/s13104-019-4823-x. ISSN 1756-0500. PMC 6889621. PMID 31791408.
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