Lamberti J Steven, Russ Ann, Cerulli Catherine, Weisman Robert L, Jacobowitz David, Williams Geoffrey C
From the Departments of Psychiatry (Drs. Lamberti, Russ, Cerulli, Weisman, and Williams, and Mr. Jacobowitz), Medicine (Dr. Williams), and Clinical and Social Sciences in Psychology (Dr. Williams), University of Rochester Medical Center.
Harv Rev Psychiatry. 2014 Jul-Aug;22(4):222-30. doi: 10.1097/01.HRP.0000450448.48563.c1.
Legal leverage is broadly defined as the use of legal authority to promote treatment adherence. It is widely utilized within mental health courts, drug courts, mandated outpatient treatment programs, and other intervention strategies for individuals with mental illness or chemical dependency who have contact with the criminal justice system. Nonetheless, the ethics of using legal authority to promote treatment adherence remains a hotly debated issue within public and professional circles alike. While critics characterize legal leverage as a coercive form of social control that undermines personal autonomy, advocates contend that it supports autonomy because treatment strategies using legal leverage are designed to promote health and independence. Despite the controversy, there is little evidence regarding the impact of legal leverage on patient autonomy as experienced and expressed by patients themselves. This report presents findings from a qualitative study involving six focus groups with severely mentally ill outpatients who received legal leverage through three forensic assertive community treatment (FACT) programs in Northeastern, Midwestern, and West Coast cities. Findings are discussed in the context of the self-determination theory of human motivation, and practical implications for the use of legal leverage are considered.
法律手段被广泛定义为利用法律权威来促进治疗依从性。它在心理健康法庭、毒品法庭、强制门诊治疗项目以及其他针对与刑事司法系统有接触的精神疾病或药物依赖个体的干预策略中被广泛使用。尽管如此，利用法律权威来促进治疗依从性的伦理问题在公众和专业人士圈子中仍是一个激烈争论的话题。批评者将法律手段描述为一种破坏个人自主性的强制性社会控制形式，而支持者则认为它支持自主性，因为使用法律手段的治疗策略旨在促进健康和独立。尽管存在争议，但关于法律手段对患者自身体验和表达的患者自主性的影响，几乎没有证据。本报告展示了一项定性研究的结果，该研究涉及六个焦点小组，这些小组由患有严重精神疾病的门诊患者组成，他们通过东北部、中西部和西海岸城市的三个法医积极社区治疗（FACT）项目接受了法律手段。研究结果在人类动机的自我决定理论背景下进行了讨论，并考虑了法律手段使用的实际影响。
