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Two scales for measuring patients’ perceptions for coercion during mental hospital admission
Abstract
Legal and extra-legal coercion are pervasive in mental hospital admission and there are sharp disputes about its appropriate role. This article presents two scales for measuring psychiatric patients' perceptions of coercion during hospital admission and reports data on these scales' internal consistency. We measure patients' perceptions of coercion by asking questions, in either an interview or questionnaire format, about their experience of lack of control, choice, influence, and freedom in hospital admission. Patients' responses to questions about their perceptions of coercion were highly internally consistent. The internal consistency of the scale was robust with respect to variation in site, instrument format, patient population, and interview procedure. Correspondence analysis was used to construct two numerical scales of perceived coercion.
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“Notably, most studies focused on inpatient settings and relied heavily on standardized tools, such as the MacArthur Admission Experience Survey [188] or the Coercion Ladder [189], to measure coercion.”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [188]
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“The scale has been shown to have a high internal consistence and validity (Gardner et al., 1993; Hiday et al., 1997).”
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Do research payments precipitate drug use or coerce participation?
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Coercion and informed consent in research involving prisoners
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Compulsory community and involuntary outpatient treatment for people with severe mental disorders
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Compulsory Substance Abuse Treatment: An Overview of Recent Findings and Issues
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Fiorillo, A., Rosa, C. D., VECCHIO, V. D., Jurjanz, L., Schnall, K., Onchev, G., Alexiev, S., Raboch, J., Kališová, L., Mastrogianni, A., et al. (2010) · European Psychiatry · doi:10.1016/j.eurpsy.2010.01.013 · Cited by 128
Swanson, J. W., Swartz, M. S., Ferron, J. C., Elbogen, E. B., & Dorn, R. A. V. (2006) · PubMed · Cited by 119
Patient perceptions of coercion in mental hospital admission
Hiday, V. A., Swartz, M. S., Swanson, J., & Wagner, H. R. (1997) · International Journal of Law and Psychiatry · doi:10.1016/s0160-2527(97)00004-6 · Cited by 120
Experiences of Individuals Who Were Physically Restrained in the Emergency Department
Wong, A. H.-W., Ray, J. M., Rosenberg, A. P., Crispino, L. J., Parker, J., McVaney, C., Iennaco, J. D., Bernstein, S. L., & Pavlo, A. J. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.19381 · Cited by 126
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JOHANSSON, I. M., & LUNDMAN, B. (2002) · Journal of Psychiatric and Mental Health Nursing · doi:10.1046/j.1365-2850.2002.00547.x · Cited by 114
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Factual sources of psychiatric patients’ perceptions of coercion in the hospital admission process
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“Perceived coercion in mental health treatment was measured using the MacArthur Admission Experience Scale (Gardner et al., 1993) as adapted for assessing coercion in outpatient treatment experience (Swartz et al., 2002).”
MethodSocioeconomic Stratification and Mental Disorder
Eaton, W. W., Muntaner, C., & Sapag, J. C. (2009) · Cambridge University Press eBooks · doi:10.1017/cbo9780511984945.016 · Cited by 109
Outpatient commitment: The state of empirical research on its outcomes.
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“The other two subscales of the AES, perceived negative pressures (six items) and process exclusion (four items) were calculated following the procedure recommended by Hiday et al. (9).”
BackgroundMethodInfluentialFestinger, D. S., Marlowe, D. B., Dugosh, K. L., Croft, J. R., & Arabia, P. L. (2008) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2008.02.007 · Cited by 101
“Therefore, as in our previous study (Festinger et al., 2005) we used a modified version of the Perceived Coercion Scale of the MacArthur Admission Experience Survey (MAES; Gardner et al., 1993).”
MethodPatients’ Revisions of Their Beliefs About the Need for Hospitalization
Gardner, W., Lidz, C. W., Hoge, S. K., Monahan, J., Eisenberg, M. M., Bennett, N. S., Mulvey, E. P., & Roth, L. H. (1999) · American Journal of Psychiatry · doi:10.1176/ajp.156.9.1385 · Cited by 128
“In a previous article (5), we reported psychometric analyses of four questions in the Admission Experience Inter-”
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“It consisted of 31 questions focusing on (1) patients’ experiences with forced medication and seclusion during their current period of hospitalization, and (2) the method of containment they would prefer in a future emergency, and also (3) perceived coercion, measured by a slightly adapted version of the Perceived Coe…”
Assessing Suitability for Offender Rehabilitation
Casey, S., Day, A., Howells, K., & Ward, T. J. (2007) · Criminal Justice and Behavior · doi:10.1177/0093854807305827 · Cited by 91
“Part of the MacArthur Admission Experience Interview, the PCS assesses individual perceptions of freedom, influence, control, volition, and choice.”
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“The most commonly used measure of perceived coercion in addiction treatment settings is the MacArthur Perceived Coercion Scale (MPCS), developed by researchers with the MacArthur Research Network to assess the perceptions of psychiatric inpatients of hospital admission processes [76].”
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"Coercion Experience Scale" (CES) - validation of a questionnaire on coercive measures
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Why do some voluntary patients feel coerced into hospitalisation? A mixed-methods study
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“Scores ranged from 0 to 5 with higher scores indicating higher levels of coercion and the scale has been widely used and validated with inpatients (Gardner et al., 1993; Lidz et al., 1995, 1998; Kallert et al., 2005).”
MethodCoerced Hospital Admission and Symptom Change—A Prospective Observational Multi-Centre Study
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Ethical and regulatory considerations in HIV prevention studies employing respondent-driven sampling
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Perceived Coercion at Hospital Admission and Adherence to Mental Health Treatment After Discharge
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Assessment of coercive and noncoercive pressures to enter drug abuse treatment
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Coercion and the outcome of psychiatric hospitalization
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“A modified version of the MacArthur Admission Experience Survey (AES) was used to assess participants' experience of coercion in outpatient treatment (Gardner et al., 1993; Swartz et al., 2002).”
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Patient characteristics and symptoms associated with perceived coercion during hospital treatment
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“, 2003) and has demonstrated psychometrically sound properties which are comparable to more lengthy interview-based measures of perceived coercion (Gardner et al., 1993).”
BackgroundMiller, V. A., Reynolds, W. W., Ittenbach, R. F., Luce, M. F., Beauchamp, T. L., & Nelson, R. M. (2009) · Journal of Empirical Research on Human Research Ethics · doi:10.1525/jer.2009.4.3.21 · Cited by 73
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Marital Status and Mental Health
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Enrollment in mental health courts: Voluntariness, knowingness, and adjudicative competence.
Redlich, A. D., Hoover, S., Summers, A., & Steadman, H. J. (2009) · Law and Human Behavior · doi:10.1007/s10979-008-9170-8 · Cited by 68
Coercive measures in psychiatric care. Reports and reactions of patients and other people involved
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Involuntary Commitment as a Psychiatric Technology
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Coercion and patient satisfaction on psychiatric acute wards
Iversen, K. I., Høyer, G., & Sexton, H. C. (2007) · International Journal of Law and Psychiatry · doi:10.1016/j.ijlp.2007.09.001 · Cited by 65
Coerced offender rehabilitation – a defensible practice?
Day, A., Tucker, K., & Howells, K. (2004) · Psychology Crime and Law · doi:10.1080/10683160410001662753 · Cited by 65
Broner, N., Mayrl, D., & Landsberg, G. (2005) · The Prison Journal · doi:10.1177/0032885504274289 · Cited by 69
“The McArthur Admission Experience Survey: Short Form (AES; 26 THE PRISON JOURNAL / March 2005 Gardner et al., 1993) in its initial validation was found to be internally consistent and across two psychiatric inpatient populations.”
MethodExamining the links between therapeutic jurisprudence and mental health court completion.
Redlich, A. D., & Han, W. (2013) · Law and Human Behavior · doi:10.1037/lhb0000041 · Cited by 63
Well-Being across the Life Course
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Patients’ experience of humiliation in the admission process to acute psychiatric wards
Svindseth, M. F., Dahl, A. A., & Hatling, T. (2007) · Nordic Journal of Psychiatry · doi:10.1080/08039480601129382 · Cited by 60
“Seven of the 15 questions of the NAES were relevant for coverage of negative events during the admission process (26).”
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Assessing Treatment Readiness in Violent Offenders
Day, A., Howells, K., Casey, S., Ward, T. J., Chambers, J. C., & Birgden, A. (2008) · Journal of Interpersonal Violence · doi:10.1177/0886260508317200 · Cited by 57
“Part of the MacArthur Admission Experience Interview, the PCS assesses individual perceptions of freedom, influence, control, volition, and choice.”
BackgroundInfluentialInterpreting the effectiveness of involuntary outpatient commitment: a conceptual model.
Swanson, J. W., Swartz, M. S., George, L. K., Burns, B. J., Hiday, V. A., Borum, R., & Wagner, H. R. (1997) · PubMed · Cited by 57
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“It should be noted that a subset of 219 subjects completed the MacArthur Perceived Coercion Scale at month twelve of the study period.”
BackgroundMethodInfluentialWatson, A. C., Angell, B., Vidalon, T. M., & Davis, K. (2010) · Journal of Community Psychology · doi:10.1002/jcop.20360 · Cited by 56
The Therapeutic Relationship After Psychiatric Admission
Roche, E., Madigan, K., Lyne, J. P., Feeney, L., & O’Donoghue, B. (2014) · Journal of Nervous & Mental Disease · doi:10.1097/nmd.0000000000000102 · Cited by 48
“To determine the level of perceived coercion, level of procedural justice, and perceived pressures an individual experienced on admission to a hospital, we used the MacArthur Admission Experience Interview (Gardner et al., 1993).”
MethodFamily, Clinician, and Patient Perceptions of Coercion in Mental Hospital Admission
Hoge, S. K., Lidz, C. W., Eisenberg, M., Monahan, J., Bennett, N., Gardner, W., Mulvey, E. P., & Roth, L. (1998) · International Journal of Law and Psychiatry · doi:10.1016/s0160-2527(98)00002-8 · Cited by 54
Coercive interactions in a psychiatric emergency room
Lidz, C. W., Mulvey, E. P., Arnold, R. P., Bennett, N. S., & Kirsch, B. L. (1993) · Behavioral Sciences & the Law · doi:10.1002/bsl.2370110305 · Cited by 54
Watson, A. C., & Angell, B. (2012) · Psychology Public Policy and Law · doi:10.1037/a0027931 · Cited by 54
Adverse Impact of Coercive Treatments on Psychiatric Inpatients’ Satisfaction with Care
Strauss, J. L., Zervakis, J. B., Stechuchak, K. M., Olsen, M. K., Swanson, J., Swartz, M. S., Weinberger, M., Marx, C. E., Calhoun, P. S., Bradford, D. W., et al. (2013) · Community Mental Health Journal · doi:10.1007/s10597-012-9539-5 · Cited by 52
Secluded and restrained patients' perceptions of their treatment
Soininen, P., Valimaki, M. A., Noda, T., Puukka, P. J., Korkeila, J. A., Joffe, G., & Putkonen, H. (2012) · International Journal of Mental Health Nursing · doi:10.1111/j.1447-0349.2012.00838.x · Cited by 52
“The MacArthur Admission Experience Interview and Survey is an instrument that assesses patients’ experience of coercion, but it refers only to the hospital admission process (Gardner et al. 1993; Wallsten et al. 2006).”
Gowda, G. S., Lepping, P., Noorthoorn, E. O., Ali, S. F., Kumar, C. N., Raveesh, B. N., & Math, S. B. (2018) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2018.05.024 · Cited by 50
Osborn, D., Lloyd‐Evans, B., Johnson, S., Gilburt, H., Byford, S., Leese, M., & Slade, M. (2010) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.110.081109 · Cited by 51
Patient Perception of Coercion on Admission to Acute Psychiatric Services
McKenna, B. G., Simpson, A. I. F., & Laidlaw, T. M. (1999) · International Journal of Law and Psychiatry · doi:10.1016/s0160-2527(98)00039-9 · Cited by 50
PRENDERGAST, M. L., Greenwell, L., Farabee, D. J., & Hser, Y. (2008) · The Journal of Behavioral Health Services & Research · doi:10.1007/s11414-008-9117-3 · Cited by 49
Cookson, A., Daffern, M., & Foley, F. (2012) · International Journal of Mental Health Nursing · doi:10.1111/j.1447-0349.2011.00764.x · Cited by 48
Short-term outcome of inpatient psychiatric care—impact of coercion and treatment characteristics
Wallsten, T., Kjellin, L., & Lindström, L. (2006) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-006-0131-6 · Cited by 48
“It involves two different instruments for measuring perceived coercion, one being the MacArthur Perceived Coercion Scale (MPCS) [10] and the other the Coercion Ladder (CL).”
MethodInfluentialEnhancing the informed consent process: a conceptual overview
Eyler, L. T., & Jeste, D. V. (2006) · Behavioral Sciences & the Law · doi:10.1002/bsl.691 · Cited by 49
Perceived Coercion and Treatment Adherence in an Outpatient Commitment Program
Rain, S. D., Steadman, H. J., & Robbins, P. C. (2003) · Psychiatric Services · doi:10.1176/appi.ps.54.3.399 · Cited by 48
Are depot antipsychotics more coercive than tablets?: The patient’s perspective
Patel, M., de Zoysa, N., Bernadt, M., Bindman, J., & David, A. (2010) · Journal of Psychopharmacology · doi:10.1177/0269881109103133 · Cited by 47
Work and Unemployment as Stressors
Lennon, M. C., & Limonic, L. (2009) · Cambridge University Press eBooks · doi:10.1017/cbo9780511984945.015 · Cited by 46
Mielau, J., Altunbay, J., Gallinat, J., Heinz, A., Bermpohl, F., Lehmann, A. I., & Montag, C. (2015) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-015-0598-9 · Cited by 45
Dugosh, K. L., Festinger, D. S., Croft, J. R., & Marlowe, D. B. (2010) · Journal of Empirical Research on Human Research Ethics · doi:10.1525/jer.2010.5.1.93 · Cited by 45
“…in research (e.g., Circumstances, Motivation, Readiness, and Suitability Scale: DeLeon et al., 1994; MacArthur Admission Experience Survey (MAES): Gardner et al., 1993; Perception of Legal Pressure Questionnaire: Young & Belenko, 2002; Survey of Treatment Entry Pressures: Marlowe et al., 1996,…”
Differences in perceived coercion at admission to psychiatric hospitals in the Nordic countries
Kjellin, L., Høyer, G., Engberg, M., Kaltiala-Heino, R., & Sigurjónsdóttir, M. (2006) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-005-0024-0 · Cited by 44
“In Sweden, local centre was a significant explanatory variable for CL (Table 4). j Voluntary patients There were significant differences between countries in the proportion of voluntary patients stating that they came involuntarily to the hospital (Table 2), but no differences in CL and MPCS scores, either between cou…”
BackgroundMethodInfluential
Metadata
- Authors
- Gardner, W., Hoge, S. K., Bennett, N., Roth, L. H., Lidz, C. W., Monahan, J., & Mulvey, E. P.
- Affiliations
- University of Pittsburgh (US)
- Corresponding author
- Gardner, William
- Venue
- Behavioral Sciences & the Law
- Publisher
- Wiley
- Published
- 1993-06
- Volume
- 11
- Issue
- 3
- Pages
- 307-321
- ISSN
- 0735-3936 (ISSN-L)
- 1099-0798
- OpenAlex
- W2155774656
- Cited by
- 342
- References
- 10
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 9 · 2023: 6 · 2022: 5 · 2021: 10 · 2020: 6 · 2019: 3 · 2018: 10 · 2017: 40 · 2016: 11 · 2015: 13 · 2014: 11 · 2013: 13 · 2012: 14
- FWCI
- 7.53
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behavioral Sciences & the Law (publishedVersion)
- PubMed (publishedVersion)
- The Journal of the American Medical Association (JAMA) Network (American Medical Association) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Keywords
- coercion, psychiatric hospital admissions, patient perspectives, internal consistency, involuntary psychiatric admission, patient autonomy, freedom of choice
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Mental Disorders, Coercion, Female, Hospitalization, Humans, Male, Middle Aged, Psychometrics, Surveys and Questionnaires, Observer Variation, Multivariate Analysis, Linear Models
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