Prevalence of Current Clinical Leverage and Association with Perceived Coercion in Outpatient and Community Psychiatric Settings: A First in Canada Study
Abstract
Clinical leverages and pressures are often utilized in psychiatric treatment settings. Clinicians know they are controversial but think of them as useful and relatively harmless. Perception of coercion is known to be deleterious to therapeutic relationship and clinical outcomes. We assessed individuals (N = 137) receiving care in outpatient and community psychiatric settings in a Canadian urban center regarding their current experiences of clinical leverage (in finance, housing, access to/custody of children, and family), and perception of coercion. Analyses show clinical leverage are common (34.8% overall), with access to child and family (15.7%), and financial (14.6%) leverages being most common. Generalised linear models indicated that psychiatric symptomology (p < 0.001) and current financial leverage (p = 0.035) were positively associated with perceptions of coercion. The results highlight that clinical leverages are widespread, associated with perception of coercion, and are likely harmful with negative impact on patient care and outcomes. Efforts to mitigate these impacts are needed.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Many studies have found a positive association between perceived coercion and the use of threats, leverage, or displays of force.
“Many studies have found a positive association between perceived coercion and the use of threats, leverage, or displays of force [41,45,47,48,65,85,162].”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [162]
Cites
Two scales for measuring patients’ perceptions for coercion during mental hospital admission
Gardner, W., Hoge, S. K., Bennett, N., Roth, L. H., Lidz, C. W., Monahan, J., & Mulvey, E. P. (1993) · Behavioral Sciences & the Law · doi:10.1002/bsl.2370110308 · Cited by 342 · see citing works
Treatment pressures, leverage, coercion, and compulsion in mental health care
Szmukler, G., & Appelbaum, P. S. (2008) · Journal of Mental Health · doi:10.1080/09638230802052203 · Cited by 304 · see citing works
Perceived Coercion and the Therapeutic Relationship: A Neglected Association?
Sheehan, K. A., & Burns, T. (2011) · Psychiatric Services · doi:10.1176/ps.62.5.pss6205_0471 · Cited by 148 · cited 1× · see citing works
“…admission (O’Donoghue et al., 2014), involuntarily admitted patients, and those with a poor thera‑ peutic relationship with their service providers (Sheehan & Burns, 2011; Theodoridou et al., 2012) are known to have high levels of perceived coercion—these are factors the cur‑ rent study did not…”
Therapeutic relationship in the context of perceived coercion in a psychiatric population
Theodoridou, A., Schlatter, F., Ajdacic, V., Rössler, W., & Jäger, M. (2012) · Psychiatry Research · doi:10.1016/j.psychres.2012.04.012 · Cited by 147 · cited 1× · see citing works
“…et al., 2014), involuntarily admitted patients, and those with a poor thera‑ peutic relationship with their service providers (Sheehan & Burns, 2011; Theodoridou et al., 2012) are known to have high levels of perceived coercion—these are factors the cur‑ rent study did not address, but are…”
Compulsory community and involuntary outpatient treatment for people with severe mental disorders.
Kisely, S. R., Campbell, L. A., & O'Reilly, R. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004408.pub5 · Cited by 123 · see citing works
Coercion in psychiatric care: Systematic review of correlates and themes
Newton-Howes, G., & Mullen, R. (2011) · Psychiatric Services · doi:10.1176/ps.62.5.pss6205_0465 · Cited by 114 · see citing works
Jaeger, M., & Rossler, W. (2010) · Psychiatry Research · doi:10.1016/j.psychres.2009.09.011 · Cited by 77 · see citing works
Patient characteristics and symptoms associated with perceived coercion during hospital treatment
Fiorillo, A., Giacco, D., De Rosa, C., Kallert, T., Katsakou, C., Onchev, G., Raboch, J., Mastrogianni, A., Del Vecchio, V., Luciano, M., et al. (2012) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2011.01809.x · Cited by 76 · see citing works
Outpatient commitment and coercion in New Zealand: A matched comparison study
McKenna, B. G., Simpson, A. I. F., & Coverdale, J. H. (2006) · International Journal of Law and Psychiatry · doi:10.1016/j.ijlp.2004.07.004 · Cited by 43 · see citing works
Kisely, S., Zirnsak, T., Corderoy, A., Ryan, C. J., & Brophy, L. (2024) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/00048674241246436 · Cited by 25 · cited 1× · see citing works
“…found little to no efficacy in its use (Kisely et al., 2017, 2023), and have argued that their infringement on civil liberty, erosion of a trusting and thera‑ peutic relationship, and negative effect on quality of life and stigma are serious concerns (Burns & Dawson, 2009; Kisely et al., 2024).”
Kisely, S., McMahon, L., & Siskind, D. (2023) · BJPsych Open · doi:10.1192/bjo.2023.28 · Cited by 23 · see citing works
Galon, P., & Wineman, N. M. (2011) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2010.10.004 · Cited by 17 · cited 1× · see citing works
“Research shows that the more a patient perceives that a treatment decision process to be just, the less perceived coercion there is (Galon & Wineman, 2011; Nakhost et al., 2018; Newton‑Howes & Mullen, 2011).”
Flagged first, then by citations
Cited by
Sorted by citations
Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review
Lessard-Deschênes, C., Pariseau-Legault, P., Billé, V., Sergerie-Richard, S., Hudson, E., Silva, B., Drouin, J.-S., Désilets, M., & Goulet, M.-H. (2025) · Healthcare · doi:10.3390/healthcare13151868 · Cited by 10 · see citing works
- Authors
- Nakhost, A., Sirotich, F., Simpson, A. I. F., & Law, S.
- Affiliations
- University of Toronto (CA)
- Centre for Addiction and Mental Health (CA)
- St. Michael's Hospital (CA)
- Corresponding author
- Law, Samuel
- Venue
- Community Mental Health Journal
- Published
- 2025-01-16
- Volume
- 61
- Issue
- 6
- Pages
- 1037-1046
- ISSN
- 0010-3853 (ISSN-L)
- 1573-2789
- OpenAlex
- W4406408308
- Cited by
- 1
- References
- 12
- Citations by year
- 2025: 1
- FWCI
- 1.18
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Community Mental Health Journal (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Ontario Academic Health Science Centre Alternate Funding Plan Innovation Funds ((SMH-17–008))
- 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 › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Keywords
- perceived coercion, psychiatric treatment, outpatient psychiatric care, leverage, child custody, psychiatric symptom severity, therapeutic relationship, coercion in mental health care
- MeSH terms
- Adult, Ambulatory Care, Mental Disorders, Canada, Coercion, Community Mental Health Services, Female, Humans, Male, Middle Aged, Outpatients, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
