title: Perceived coercion among jail diversion participants in a multisite study.
abstract: OBJECTIVE
  Although jail diversion is considered an appropriate and humane response to the disproportionately high volume of people with mental illness who are incarcerated, little is known regarding the perceptions of jail diversion participants, the extent to which they feel coerced into participating, and whether perceived coercion reduces involvement in mental health services. This study addressed perceived coercion among participants in postbooking jail diversion programs in a multisite study and examined characteristics associated with the perception of coercion.
  
  
  METHODS
  Data collected in interviews with 905 jail diversion participants from 2003 to 2005 were analyzed with random-effects proportional odds models.
  
  
  RESULTS
  Ten percent of participants reported a high level of coercion, and another 26% reported a moderate level of coercion. Having a drug charge was associated with lower perceived coercion to enter the program. In addition, an interaction between sexual abuse and substance abuse indicated that recent sexual abuse was associated with higher levels of perceived coercion, but only among those without current substance abuse. At the 12-month follow-up (N=398), variables associated with higher perceived coercion to receive behavioral health services included spending more time in jail and higher perceived coercion at baseline. The amount of behavioral health service use was not predicted by perceived coercion at baseline. Rather, being older, having greater symptom severity, and having a history of sexual abuse but no substance abuse and no history of physical abuse were associated with higher levels of outpatient service use.
  
  
  CONCLUSIONS
  Overall, one-third of jail diversion participants reported some level of perceived coercion. Important determinants of perceived coercion included charge type, length of time in jail, and sexual abuse history. Engagement in treatment was not affected by perceived coercion.
authors.affiliation: Department of Psychiatry and Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 356 Medical School Wing C, CB 7160, Chapel Hill, NC 27599, USA. kcusack@schsr.unc.edu
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Cusack
authors.forename: Henry J
authors.initials: HJ
authors.lastname: Steadman
authors.forename: Amy H
authors.initials: AH
authors.lastname: Herring
mesh_terms: D000328:Adult; D003068:Coercion; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D001523:Mental Disorders; D008605:Mental Health Services; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010465:Perception; D011329:Prisoners / Q000523:psychology*; D014481:United States
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