Outpatient commitment and coercion in New Zealand: A matched comparison study
Abstract
Background It has been hypothesized that a degree of coercion is a necessary component in using outpatient commitment to attain therapeutic outcome for those people subject to mental health law. However, what degree of coercion is required and how it is sustained is poorly understood. There is speculation that patients' recognition of beneficial as well as unwanted aspects of outpatient commitment (ambivalence) maybe an indicator that the necessary level of coercion has been achieved to facilitate a therapeutic outcome.Aim The aim of this study was to determine the level of coercion perceived by those under outpatient commitment in New Zealand. Emphasis was given to consideration of the presence of ambivalence and the role of interactive processes, including procedural justice, in influencing patients' perceptions of coercion.Method A cross-sectional comparative study was undertaken to compare the perceptions of coercion of patients on outpatient commitment (n = 69) to a matched sample of voluntary outpatients (n = 69), using the Perceived Coercion Scale. The influence of a range of variables, including patients' knowledge of and beliefs concerning outpatient commitment, were considered.Results Although the level of coercion for involuntary outpatients was relatively low, it was significantly higher than that experienced by voluntary outpatients. Yet involuntary outpatients were more likely to espouse benefits of outpatient commitment. Although there was an inverse correlation between perceptions of procedural justice and perceived coercion, procedural justice did not feature in the linear regression analysis.Discussion In the New Zealand context, involuntary outpatients hold contrasting views to outpatient commitment. We suggest that this ambivalence is an indicator that the degree of coercion is suffice to achieve therapeutic outcome. Furthermore, this study suggests the impact of procedural justice on patients' perceptions of coercion may be more crucial during admission to hospital than in the context of on-going community care.
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Several studies found no significant association between race and perceived coercion.
“However, several studies found no significant association between race and perceived coercion [15,65,78,89,103,130,154].”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [65]
Living situation was not significantly associated with perceived coercion in any of the seven studies examining this factor.
“Living situation was not significantly associated with perceived coercion in any of the seven studies examining this factor [15,36,65,89,117,123,139].”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [65]
The belief that refusing treatment would lead to involuntary admission or police intervention was linked to greater perceived coercion.
“The belief that refusing treatment would lead to involuntary admission or police intervention was also linked to greater perceived coercion [65].”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [65]
Patients subjected to outpatient commitment were more likely to perceive coercion.
“Patients subjected to outpatient commitment were more likely to perceive coercion [24,57,65,92,95,107]”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [65]
Several studies found no correlation between perceived coercion and socioeconomic status.
“Several studies found no correlation between perceived coercion and socioeconomic status [41,65]”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [65]
Several studies found no correlation between perceived coercion and employment.
“or employment [65,89,117,154].”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [65]
No association with religion was found in one New Zealand study.
“while the other, from New Zealand, found no association with the religion of participants [65].”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [65]
Having a partner was associated with lower perceived coercion in one study.
“having a partner was associated with lower perceived coercion in one study [65]”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [65]
In outpatient care, individuals who experienced sadness, anger, confusion, or fear reported higher levels of perceived coercion.
“In outpatient care, individuals who experienced sadness, anger, confusion, or fear reported higher levels of perceived coercion”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [65]
Reported threats included the possibility of outpatient commitment, changes in legal status, discharge, changes in medication, unit transfers, negative consequences, and loss of privileges.
“Reported threats included the possibility of outpatient commitment [65], changes in legal status [130], discharge [110], changes in medication [141], unit transfers [130], negative consequences [47], and loss of privileges [68,110,130,141].”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [65]
Experiences of persuasion were associated with higher perceived coercion in one study.
“experiences of persuasion were associated with higher perceived coercion in one study [65].”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [65]
In outpatient care, individuals who felt happiness or relief reported lower levels of perceived coercion.
“whereas those who felt happiness or relief reported lower levels [65].”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [65]
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 [65]
Inducement showed no significant association with perceived coercion.
“While inducement showed no significant association with perceived coercion, experiences of persuasion were associated with higher perceived coercion in one study [65].”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [65]
Higher perceived coercion scores were associated with individuals who did not believe they needed treatment or had a mental illness.
“and among individuals who did not believe they needed treatment or had a mental illness [65]”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [65]
Numerous quantitative studies have found an inverse relationship between levels of procedural justice and levels of perceived coercion.
“Numerous quantitative studies have found an inverse relationship between levels of procedural justice and levels of perceived coercion [15,24,34,38,42,45,48,54,55,65,92,95,105,107,147,156].”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [65]
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- Authors
- McKenna, B. G., Simpson, A. I. F., & Coverdale, J. H.
- Affiliations
- University of Auckland (NZ)
- Corresponding author
- McKenna, Brian G.
- Venue
- International Journal of Law and Psychiatry
- Publisher
- Elsevier BV
- Published
- 2006-03
- Volume
- 29
- Issue
- 2
- Pages
- 145-158
- ISSN
- 0160-2527 (ISSN-L)
- OpenAlex
- W2065146394
- Cited by
- 43
- References
- 48
- Citations by year
- 2025: 2 · 2024: 1 · 2023: 2 · 2021: 1 · 2020: 3 · 2019: 3 · 2018: 2 · 2017: 1 · 2016: 3 · 2015: 2 · 2013: 2 · 2012: 3
- FWCI
- 2.58
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Law and Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Research Bank (Australian Catholic University) (submittedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- ResearchSpace (University of Auckland) (submittedVersion)
- Funders
- John D. and Catherine T. MacArthur Foundation
- Topics
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Health Sciences › Health Professions › General Health Professions › Health, Medicine and Society
- Keywords
- outpatient commitment, coercion, mental health law, involuntary psychiatric admission, ambivalence, procedural justice, patient perspectives, treatment outcomes, New Zealand
- MeSH terms
- Adult, Aged, Ambulatory Care, Mental Disorders, Coercion, Commitment of Persons with Psychiatric Disorders, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, New Zealand, Time Factors
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