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Pressures to adhere to treatment ('leverage') in English mental healthcare.
MedLine Citation:
PMID:  21804149     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Background Coercion has usually been equated with legal detention. Non-statutory pressures to adhere to treatment, 'leverage', have been identified as widespread in US public mental healthcare. It is not clear if this is so outside the USA. Aims To measure rates of different non-statutory pressures in distinct clinical populations in England, to test their associations with patient characteristics and compare them with US rates. Method Data were collected by a structured interview conducted by independent researchers supplemented by data extraction from case notes. Results We recruited a sample of 417 participants from four differing clinical populations. Lifetime experience of leverage was reported in 35% of the sample, 63% in substance misusers, 33% and 30% in the psychosis samples and 15% in the non-psychosis sample. Leverage was associated with repeated hospitalisations, substance misuse diagnosis and lower insight as measured by the Insight and Treatment Attitudes Questionnaire. Housing leverage was the most frequent form (24%). Levels were markedly lower than those reported in the USA. Conclusions Non-statutory pressure to adhere to treatment (leverage) is common in English mental healthcare but has received little clinical or research attention. Urgent attention is needed to understand its variation and place in community practice.
Authors:
Tom Burns; Ksenija Yeeles; Andrew Molodynski; Helen Nightingale; Maria Vazquez-Montes; Kathleen Sheehan; Louise Linsell
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The British journal of psychiatry : the journal of mental science     Volume:  199     ISSN:  1472-1465     ISO Abbreviation:  Br J Psychiatry     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-08-01     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0342367     Medline TA:  Br J Psychiatry     Country:  England    
Other Details:
Languages:  eng     Pagination:  145-50     Citation Subset:  IM    
Affiliation:
MD, DSc, FRCPsych, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK. tom.burns@psych.ox.ac.uk.
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