"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