Swartz Marvin S, Swanson Jeffrey W, Hannon Michael J
Division of Social and Community Psychiatry, Duke University School of Medicine, DUMC Box 3173/238 Civitan Building, Durham, NC 27710, USA.
Behav Sci Law. 2003;21(4):459-72. doi: 10.1002/bsl.539.
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.
长期以来，心理健康消费者权益倡导者一直认为，非自愿治疗会使精神障碍患者感到恐惧，从而阻碍他们主动寻求帮助。我们对85名心理健康专业人员和104名患有精神分裂症谱系疾病的个体进行了调查，以评估他们对非自愿治疗和其他治疗指令的体验及看法。在临床医生中，78%报告称，总体而言，他们认为法律压力使他们的精神分裂症患者更有可能坚持治疗。关于非自愿门诊治疗强制令，81%的临床医生不同意强制社区治疗会阻碍精神分裂症患者未来寻求自愿治疗这一观点。在消费者样本中，63%报告有非自愿住院治疗的终生经历，而36%报告称害怕强制治疗是寻求心理健康问题帮助的障碍——在此称为“与强制治疗相关的护理障碍”。在双变量分析中，有非自愿住院治疗终生经历、刑事法庭要求治疗以及有法定监护人的受试者，因害怕强制治疗（与强制治疗相关的护理障碍）而不愿寻求门诊治疗的可能性显著更高。然而，非自愿门诊治疗强制令的经历与寻求治疗的障碍并无关联。近期关于不遵守治疗潜在后果的提醒或警告、近期住院治疗以及较高程度的感知强制通常也与与强制治疗相关的护理障碍有关。在多变量分析中，仅发现非自愿住院治疗和近期关于不遵守治疗的警告与这些障碍显著相关。这些结果表明，强制治疗可能成为治疗的障碍，但持续存在的坚持治疗的非正式压力也可能是重要的治疗障碍。
