title: Effects of legal mechanisms on perceived coercion and treatment adherence among persons with severe mental illness.
abstract: This study takes preliminary steps to examine the effects of 2 legal mechanisms-outpatient commitment (OPC) and representative payeeship (rep payee)-on perceived coercion and treatment adherence in persons with severe mental illness (SMI). Data were collected in structured interviews from 258 involuntarily-admitted inpatients with SMI who were followed for 1 year after discharge. Subjects' clinicians and family members were also interviewed. The analyses show that subjects with both OPC and a rep payee perceived their mental health treatment to be significantly more coercive than subjects who did not receive these legal interventions. Duration of OPC and having a newly-appointed rep payee were both significantly associated with increased treatment adherence over the course of 1 year. For treatment-adherent subjects, neither form of legal mechanism was associated with perceived coercion in treatment, whereas subjects who were nonadherent perceived legal mechanisms as significantly more coercive. The data suggest that these legal tools both affect adherence to treatment, but when used together significantly increase the perceived coerciveness of treatment. Questions remain concerning the underlying mechanism of these effects.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Elbogen
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Swanson
authors.forename: Marvin S
authors.initials: MS
authors.lastname: Swartz
mesh_terms: D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D003068:Coercion; D003134:Commitment of Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence*; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000523:psychology*; D016017:Odds Ratio; D010349:Patient Compliance / Q000523:psychology*; D010465:Perception