Coercion, competence, and consent in offenders with personality disorder.
Competence to consent to treatment has not previously been examined in a personality disorder cohort without comorbid mental disorder. We examined competence and coercion in 174 individuals diagnosed with severe personality disorder using two validated tools (the MacArthur Competence Assessment Tool for Treatment and the MacArthur Coercion Assessment Scale - Short Form). Competence was not categorically impaired, but there were variations within the sample on dimensional competence measures. Further, there were significant negative correlations between experienced coercion and competence. Higher coercion scores were associated with two components of competence: lower understanding and reasoning. Patients who consented to treatment had higher scores on competence measures and experienced less coercion. These findings suggest that therapeutic approaches that decrease experienced coercion and increase competence may increase the engagement of individuals diagnosed with severe personality disorders in treatment.
Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK.
J
J
Zlodre
Institute of Psychiatry, King's College London, London, UK.
J
J
Yiend
Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
T
T
Burns
Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
S
S
Fazel
Competence; coercion; informed consent; offenders with mental disorder; personality disorder