Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK.
Br J Psychiatry. 2011 Aug;199(2):145-50. doi: 10.1192/bjp.bp.110.086827.
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.
强制通常等同于法律拘留。在美国公共精神卫生保健中，已经确定存在广泛的非法定压力来要求患者坚持治疗，即“利用”。目前尚不清楚这种情况在美国以外是否存在。
在英格兰的不同临床人群中测量不同非法定压力的发生率，检验它们与患者特征的关联，并与美国的发生率进行比较。
通过独立研究人员进行的结构化访谈收集数据，并通过从病历中提取数据进行补充。
我们从四个不同的临床人群中招募了 417 名参与者。在该样本中，有 35%的人报告在一生中经历过“利用”，在物质滥用者中为 63%，在精神病样本中为 33%和 30%，在非精神病样本中为 15%。“利用”与反复住院、物质滥用诊断以及较低的洞察力（由洞察力和治疗态度问卷测量）相关。住房“利用”是最常见的形式（24%）。水平明显低于美国报告的水平。
在英国的精神卫生保健中，非法定的治疗依从性压力（“利用”）很常见，但很少受到临床或研究的关注。迫切需要关注其变化及其在社区实践中的地位。
