Pridham Katherine M Francombe, Berntson Andrea, Simpson Alexander I F, Law Samuel F, Stergiopoulos Vicky, Nakhost Arash
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:
Psychiatr Serv. 2016 Jan;67(1):16-28. doi: 10.1176/appi.ps.201400538. Epub 2015 Oct 1.
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.
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.
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.
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.
各种形式的强制性精神科社区治疗令（CTOs）在国际上被广泛使用。由于强制患者接受治疗存在伦理问题，CTOs仍然存在争议。了解患者对CTOs的体验有助于发展更以患者为中心、以康复为重点的社区护理。本综述研究了文献中CTOs与患者对强制的认知之间的关系。
对相关数据库从创建到2014年3月31日进行了与CTOs和患者对强制的认知相关的关键词搜索。如果出版物经过同行评审、报道原创研究、对接受或曾接受CTO的患者进行调查或访谈且用英文撰写，则将其纳入。确定了影响患者对强制认知的因素，包括研究的区域背景。
纳入了23篇主要研究文章，报道了来自7个国家的14项研究。证据表明，CTOs可能会导致患者产生被强制的感觉，不同研究中的强制程度存在显著差异。背景因素，包括对CTOs替代方案的认知、患者生活中其他形式影响力的存在以及CTO启动和执行的过程，可能会减轻或增强对强制的认知。
通过增加患者获取信息的机会、改善与服务提供者的工作关系以及建立可及、公平的程序，可以减少CTOs的强制因素。CTOs的强制方面应被视为对门诊精神科治疗中日常压力和影响力更广泛理解的一部分。
