Nakhost Arash, Sirotich Frank, Pridham Katherine M Francombe, Stergiopoulos Vicky, Simpson Alexander I F
Department of Psychiatry University of Toronto, Toronto, Ontario, Canada.
Associate Scientist, Li Ka Shing Knowledge Institute, St Michael Hospital, Toronto, Ontario, Canada.
Can J Psychiatry. 2018 Nov;63(11):757-765. doi: 10.1177/0706743718766053. Epub 2018 Apr 3.
Since the deinstitutionalization of psychiatric services around the world, the scope of outpatient psychiatric care has also increased to better support treatment access and adherence. For those with serious mental illness who may lack insight into their own illness, available interventions include coercive community practices such as mandated community treatment orders (CTOs). This paper examines the perceptions of coercion among service users treated with a CTO.
We used a cross-sectional comparative design where service users treated under a CTO were matched to a comparison group of voluntary psychiatric outpatients. Both groups were receiving intensive community mental health services ( = 69 in each group). Participants were interviewed using a series of questionnaires aimed at evaluating their perceptions of coercion and other aspects of the psychiatric treatment.
The level of coercion reported by service users treated under a CTO was significantly higher than that in the comparison group. However, in adjusted analyses, service users' perception of coercion, irrespective of their CTO status, was directly correlated with their previous experience with probation and inversely correlated with the sense of procedural justice in their treatment.
Evaluation of psychiatric service users' experiences of coercion should consider their past and current involvement with other types of coercive measures, particularly history of probation. Clinicians may be able to minimize these experiences of coercion by incorporating procedural justice principles into their practice.
自全球精神科服务去机构化以来，门诊精神科护理的范围也有所扩大，以更好地支持治疗的可及性和依从性。对于那些可能对自身疾病缺乏洞察力的严重精神疾病患者，可用的干预措施包括强制性社区措施，如强制社区治疗令（CTO）。本文探讨了接受CTO治疗的服务使用者对强制的看法。
我们采用横断面比较设计，将接受CTO治疗的服务使用者与自愿精神科门诊患者的对照组进行匹配。两组都在接受强化社区心理健康服务（每组69人）。使用一系列问卷对参与者进行访谈，旨在评估他们对强制及精神科治疗其他方面的看法。
接受CTO治疗的服务使用者报告的强制程度明显高于对照组。然而，在调整分析中，服务使用者对强制的看法，无论其CTO状态如何，都与他们以前的缓刑经历直接相关，与他们治疗中的程序正义感受呈负相关。
对精神科服务使用者强制经历的评估应考虑他们过去和当前与其他类型强制措施的接触情况，特别是缓刑历史。临床医生可以通过将程序正义原则纳入其实践来尽量减少这些强制经历。
