Perception of Coercion Among Patients With a Psychiatric Community Treatment Order: A Literature Review
Abstract
Objective Various forms of compulsory psychiatric community treatment orders (CTOs) are commonly utilized internationally. CTOs remain contentious because of the ethical implications of coercing patients to receive treatment. Understanding patients' experience of CTOs can assist in the development of more patient-centered and recovery-focused community care. This review examined the relationship between CTOs and patients' perceptions of coercion in the literature. Methods A search of key terms relating to CTOs and patients' perceptions of coercion was conducted of relevant databases from their inception to March 31, 2014. Publications were included if they were peer reviewed, reported on original research, surveyed or interviewed patients who were or had been subject to a CTO, and were written in English. Factors influencing patients' perceptions of coercion, including the regional context of the studies, were identified. Results Twenty-three primary research articles, reporting on 14 studies from seven countries, were included. Evidence indicated that CTOs may contribute to a patient's sense of coercion, with marked variations among studies in the levels of coercion. Contextual factors, including perceptions of alternatives to CTOs, the presence of additional forms of leverage in patients' lives, and the process of CTO initiation and enforcement, may mitigate or enhance perceptions of coercion. Conclusions Coercive elements of CTOs may be reduced through increased patient ac…
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There was an inverse relationship between insight, perceptions of procedural justice and perceived coercion.
“There was an inverse relationship between insight, perceptions of procedural justice and perceived coercion”
From The benefits and harms of community treatment orders for people diagnosed with psychiatric illnesses: A rapid umbrella review of systematic reviews and meta-analyses (2024) · cites this paper as Pridham et al., 2016
Both quantitative and qualitative results indicated that people on community treatment orders felt more coerced than voluntary patients, although this varied considerably across studies.
“Both quantitative and qualitative results indicated that people on CTOs felt more coerced than voluntary patients, although this varied considerably across studies.”
From The benefits and harms of community treatment orders for people diagnosed with psychiatric illnesses: A rapid umbrella review of systematic reviews and meta-analyses (2024) · cites this paper as Pridham et al. (2016)
Both systematic reviews with quantitative harm data reported increased levels of perceived coercion in people on community treatment orders as measured by a standardised scale, although this was non-significant in one case.
“Both reported increased levels of perceived coercion in people on CTOs as measured by a standardised scale although this was non-significant in one case”
From The benefits and harms of community treatment orders for people diagnosed with psychiatric illnesses: A rapid umbrella review of systematic reviews and meta-analyses (2024) · cites this paper as Pridham et al., 2016
One systematic review highlighted confusion and disenchantment with the community treatment order legal process irrespective of jurisdiction.
“One SR highlighted confusion and disenchantment with the CTO legal process irrespective of jurisdiction”
From The benefits and harms of community treatment orders for people diagnosed with psychiatric illnesses: A rapid umbrella review of systematic reviews and meta-analyses (2024) · cites this paper as Pridham et al., 2016
Only two systematic reviews had quantitative data on potential harms, a Cochrane review and one review of predominately qualitative data.
“Only two SRs had quantitative data on potential harms, a Cochrane review and one of predominately qualitative data that is describe more fully below”
From The benefits and harms of community treatment orders for people diagnosed with psychiatric illnesses: A rapid umbrella review of systematic reviews and meta-analyses (2024) · cites this paper as Pridham et al., 2016
In general, community treatment order cases had higher scores on measures of coercion, although this only just failed to reach statistical significance in one meta-analysis of two studies (p = 0.06).
“In general, CTO cases had higher scores on measures of coercion (Pridham et al., 2016), although this only just failed to reach statistical significance in one meta-analysis of two studies (p = 0.06)”
From The benefits and harms of community treatment orders for people diagnosed with psychiatric illnesses: A rapid umbrella review of systematic reviews and meta-analyses (2024) · cites this paper as Pridham et al., 2016
Systematic reviews reported on data from standardised instruments less often, and these were largely restricted to comparing perceived coercion in people on community treatment orders with those on voluntary treatment.
“SRs reported on data from standardised instruments less often and these were largely restricted to comparing perceived coercion in people on CTOs with those on voluntary treatment”
From The benefits and harms of community treatment orders for people diagnosed with psychiatric illnesses: A rapid umbrella review of systematic reviews and meta-analyses (2024) · cites this paper as Pridham et al., 2016
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References 61 · Cited by 52
- Authors
- Pridham, K. M. F., Berntson, A., Simpson, A. I. F., Law, S. F., Stergiopoulos, V., & Nakhost, A.
- Affiliations
- Ms. Francombe Pridham, Dr. Law, Dr. Stergiopoulos, and Dr. Nakhost are with the Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada, and Dr. Law, Dr. Stergiopoulos, and Dr. Nakhost are also with the Department of Psychiatry, University of Toronto, also in Toronto, where Dr. Berntson and Dr. Simpson are affiliated (e-mail: ). Dr. Berntson is also with the Department of Psychiatry, Mount Sinai Hospital, and Dr. Simpson is also with the Centre for Addiction and Mental Health, both in...
- Mount Sinai Hospital (CA)
- Venue
- Psychiatric Services
- Published
- 2016-01-01
- Volume
- 67
- Issue
- 1
- Pages
- 16-28
- ISSN
- 0022-1597 (ISSN-L)
- 1075-2730
- 1557-9700
- OpenAlex
- W1832220617
- Cited by
- 52
- References
- 61
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 6 · 2023: 5 · 2022: 1 · 2021: 5 · 2020: 9 · 2019: 5 · 2018: 7 · 2017: 5 · 2016: 3 · 2014: 1
- FWCI
- 0.72
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychiatric Services (publishedVersion)
- PubMed (publishedVersion)
- 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
- involuntary treatment, involuntary psychiatric treatment, outpatient psychiatric care, patient-centered care, recovery-oriented care, patient-provider relationship
- MeSH terms
- Ambulatory Care, Mental Disorders, Coercion, Community Mental Health Services, Humans, Patients, Psychotherapy, Randomized Controlled Trials as Topic
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