Empowerment and Meaning Within the Context of Coercive Treatment of Individuals with Serious Mental Illness

Empowerment and Meaning Within the Context of Coercive Treatment of Individuals with Serious Mental Illness
Author: Kristen M. Strack
Publisher:
Total Pages: 162
Release: 2008
Genre:
ISBN:
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Abstract: Several approaches have utility in the treatment of individuals with serious mental illness (SMI), including mandated treatment, empowerment, and logotherapy (which emphasizes the importance of meaning in life). Mandated treatment focuses on decreasing psychological symptoms, therefore increasing functioning. Mandated treatment has been criticized due to the use of coercion to stimulate treatment adherence. The use of coercion in mental health treatment does not necessarily attend to consumer viewpoints of illness, treatment, and recovery from SMI. Individuals with SMI view recovery in terms of issues such as self-determination, meaning, and hope. Two treatment approaches that hold promise in the treatment of individuals with SMI because of their consumer-oriented nature are empowerment and logotherapy, however empirical research is limited and additional studies are warranted. The current study's primary focus was the investigation of the relationship among the variables of coercion, psychiatric symptoms, empowerment, and meaning in a sample of individuals with SMI. It was hypothesized that empowerment would be dependent on level of psychiatric symptoms and meaning, but not dependent on level of coercion. The following measures were used: the MacArthur Perceived Coercion Scale, the Empowerment Scale, the Brief Symptom Inventory, the Life Purpose Questionnaire, and the Meaning in Life Questionnaire. The participants were recruited from mental health facilities in the state of Mississippi (N = 96). This study is a cross-sectional design. A series of regression analyses were conducted to examine the major hypotheses of the study. The results suggest that empowerment is dependent on the level of presence of meaning in one's life as well as the level of current psychiatric symptoms. Thus, people endorsing higher levels of meaning and lower levels of psychiatric symptoms also endorsed higher levels of empowerment. Coercion was not predictive of empowerment. This suggests that coercion may not disempower people with SMI. In addition to these findings and their implications, an analysis of the psychometric properties of the two meaning measures used in this study (the Life Purpose Questionnaire and the Meaning in Life Questionnaire) is presented, along with a discussion of study limitations and directions for research.

Coercion and Empowerment in the Treatment of Individuals with Serious Mental Illness

Coercion and Empowerment in the Treatment of Individuals with Serious Mental Illness
Author: Kristen M. Strack
Publisher:
Total Pages: 78
Release: 2006
Genre:
ISBN:
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Abstract: Recently, treatment approaches for individuals with serious mental illness have sought to increase autonomy in an effort to prevent frequent hospitalizations. Two of these current strategies are coercive treatment and empowerment. Theoretically both coercive treatment and empowerment of individuals attempt to increase the individual's freedom from both their illness and from rehospitalization. Yet, these two approaches attempt this in very different ways. According to the theory of diachronic freedom, coercive or mandated treatment limits a person's autonomy during the time of treatment. Empowerment, on the other hand, encourages the individual to have freedom during treatment. Because of this key difference coercive treatment has often been viewed as a hindrance to empowerment. However, the theoretical conceptualization of coercive treatment closely resembles many components of empowerment. Thus, coercive treatment may not serve as a barrier to empowerment; in fact, coercive treatment may possibly foster empowerment. In an attempt to assess the model of diachronic freedom this study sought to find empirical data in support of a relationship between level of coercion, level of functioning, and level of empowerment. A cross-sectional design was utilized. Participants were recruited from mental health centers in the state of Mississippi and were at varying stages of the treatment process including both inpatient and outpatient treatment. Variables of interest were perceived coercion, functioning, and empowerment. It was found that only functioning was predictive of empowerment in this sample. This suggests that empowerment is dependent on an individual's level of functioning. In addition, the results suggest that coercion may not disempower individuals with serious mental illness.

Empowering People with Severe Mental Illness

Empowering People with Severe Mental Illness
Author: Donald M. Linhorst
Publisher: Oxford University Press
Total Pages: 368
Release: 2006
Genre: Medical
ISBN: 019517187X
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This is the first professional guide that operationalizes the theory of empowerment, outlines the conditions under which it is likely to occur, and applies a practical model for working with people with severe mental illness.

Coercion in Community Mental Health Care

Coercion in Community Mental Health Care
Author: Andrew Molodynski
Publisher: Oxford University Press
Total Pages: 402
Release: 2016-07-21
Genre: Medical
ISBN: 0191034320
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The use of coercion is one of the defining issues of mental health care. Since the earliest attempts to contain and treat the mentally ill, power imbalances have been evident and a cause of controversy. There has always been a delicate balance between respecting autonomy and ensuring that those who most need treatment and support are provided with it. Coercion in Community Mental Health Care: International Perspectives is an essential guide to the current coercive practices worldwide, both those founded in law and those 'informal' processes whose coerciveness remains contested. It does so from a variety of perspectives, drawing on diverse disciplines such as history, law, sociology, anthropology and medicine to provide a comprehensive summary of the current debates in the field. Edited by leading researchers in the field, Coercion in Community Mental Health Care: International Perspectives provides a unique discussion of this prominent issue in mental health. Divided into five sections covering origins and extent, evidence, experiences, context and international perspectives this is ideal for mental health practitioners, social scientists, ethicists and legal professionals wishing to expand their knowledge of the subject area.

Coercive Treatment in Psychiatry

Coercive Treatment in Psychiatry
Author: Thomas W. Kallert
Publisher: John Wiley & Sons
Total Pages: 350
Release: 2011-04-25
Genre: Medical
ISBN: 0470660724
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Coercion is one of the most fascinating and controversial subjects in psychiatry. It is a highly sensitive, and hotly debated topic in which clinical practice, ethics, the law and public policy converge. This book considers coercion within the healing and ethical framework of therapeutic relationships and partnerships at all levels, and addresses the universal problem of how to balance safety versus autonomy when dealing with psychiatric treatment. Coercive Treatment in Psychiatry is a much needed contribution to the literature. The first three sections deal with the conceptual and clinical aspects of coercive treatment, the legal aspects and the ethical aspects of coercive treatment. In detail, these sections cover a broad spectrum of issues: coercion in institutions and in the community, coercive treatment and stigma, the definition of best practice standards for coercive treatment, de-escalation of risk situations, recent developments in mental health legislation, mental health care and patients' rights, cross-cultural perspectives on coercive treatment, historical injustice in psychiatry, and paternalism in mental health. The fourth section features users' views on coercive treatment: giving voice to an often-unheeded population. Finally, the book addresses the original topic of coercion and undue influence in decisions to participate in psychiatric research. This book presents the first comprehensive review of the issue of coercion in psychiatry. With chapters written by the leading experts in the field, many of whom are renowned as clear thinkers and experienced clinicians, it may be seen as a starting point for international discussions and initiatives in this field aiming to minimize coercion. Highly Commended in the Psychiatry section of the 2012 BMA Book Awards.

Crossing the Quality Chasm

Crossing the Quality Chasm
Author: Institute of Medicine
Publisher: National Academies Press
Total Pages: 359
Release: 2001-07-19
Genre: Medical
ISBN: 0309132967
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Second in a series of publications from the Institute of Medicine's Quality of Health Care in America project Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America. Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers: A set of performance expectations for the 21st century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems. Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.

Forced Into Treatment

Forced Into Treatment
Author: Group for the Advancement of Psychiatry. Committee on Government Policy
Publisher: American Psychiatric Pub
Total Pages: 164
Release: 1994
Genre: Medical
ISBN: 9780873182058
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What role does coercion play in psychiatric treatment? Does it increase or decrease the chances for successful outcome? Forced Into Treatment discusses various aspects of coercion ranging from the role of coercion in initiation psychiatric treatment to its effect on treatment process and outcome. The book demonstrated that a patient who is appropriately forced into treatment can more from initial defiance, through reluctant compliance, to a successful therapeutic alliance and a successful outcome. In addition, Forced Into Treatment addresses the role of coercion, power, and authority in socializing children the use of coercive social pressure as a motivation to seek help the effects of court-ordered treatment for people who have refused psychiatric help the historical and legal aspects regarding coercive treatment

Improving the Quality of Health Care for Mental and Substance-Use Conditions

Improving the Quality of Health Care for Mental and Substance-Use Conditions
Author: Institute of Medicine
Publisher: National Academies Press
Total Pages: 528
Release: 2006-03-29
Genre: Medical
ISBN: 0309133661
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Each year, more than 33 million Americans receive health care for mental or substance-use conditions, or both. Together, mental and substance-use illnesses are the leading cause of death and disability for women, the highest for men ages 15-44, and the second highest for all men. Effective treatments exist, but services are frequently fragmented and, as with general health care, there are barriers that prevent many from receiving these treatments as designed or at all. The consequences of this are seriousâ€"for these individuals and their families; their employers and the workforce; for the nation's economy; as well as the education, welfare, and justice systems. Improving the Quality of Health Care for Mental and Substance-Use Conditions examines the distinctive characteristics of health care for mental and substance-use conditions, including payment, benefit coverage, and regulatory issues, as well as health care organization and delivery issues. This new volume in the Quality Chasm series puts forth an agenda for improving the quality of this care based on this analysis. Patients and their families, primary health care providers, specialty mental health and substance-use treatment providers, health care organizations, health plans, purchasers of group health care, and all involved in health care for mental and substanceâ€"use conditions will benefit from this guide to achieving better care.

Comparison of Health Care Context, Coercion, and Compliance in Persons with Severe and Persistent Mental Illness

Comparison of Health Care Context, Coercion, and Compliance in Persons with Severe and Persistent Mental Illness
Author: Patricia Ann McCann Galon
Publisher:
Total Pages: 0
Release: 2006
Genre: Mental illness
ISBN:
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"Persons with severe and persistent mental illness (SPMI) who do not participate in treatment, use disproportionate amounts of high intensity services, have co-occurring substance abuse disorders, and have frequent contact with the criminal justice system. Clinical management of this population may be enhanced by the use of coercive treatment including Assertive Community Treatment (ACT) and outpatient commitment (OPC). Previous research implicates procedural justice (giving the client voice during legal/treatment proceedings) as mediating the relationship between ACT/OPC and the perception of coercion, which then influences other outcomes including treatment compliance, violence/victimization, rehospitalization, and quality of life. The purpose of this research was to examine the influence of the legal context of care and treatment modalities that vary in degree of coercion on the client's perception of procedural justice and coercion, compliance with treatment, and other outcomes. The random sample included 154 adults with SPMI. This study compared OPC/ACT to evaluate the effects individually and in combination on mediating and outcome variables. The research was constructed as a quasi experiment using a 2 x 2 factorial design. Type of treatment (ACT versus Usual Care) was crossed with Outpatient Commitment Status (OPC versus no OPC). ANOVA and multiple regression procedures were used to test hypotheses. Correlations and part correlations were used to examine relationships among key variables. Findings supported that the perception of procedural justice/choice and the perception of coercion/negative pressure were inversely related. Also, procedural justice/choice, OPC status, and race were significant predictors of the perception of coercion. The bivariate relationship between procedural justice and perception of coercion were stronger for whites than for non-whites. A portion of the model was tested and confirmed a direct relationship between OPC and the perception of coercion/negative pressure and an indirect relationship between these variables through procedural justice/choice. Examination of this model for whites and non-whites separately revealed that the direct relationship between OPC and perception of coercion/negative pressure was only upheld for white subjects. Suggestions for further research, implications for clinical practice, and health care policy are delineated."--Abstract