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.
"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). This scale comprises 14 true/ false statements about an individual's hospital admission experience. "
[Show abstract][Hide abstract] ABSTRACT: The therapeutic relationship is one of the most central and important factors in the treatment of mental health disorders. A better therapeutic relationship is associated with service engagement, medication adherence, and satisfaction with services. This study aimed to compare the demographic and clinical factors associated with the therapeutic relationship in voluntarily and involuntarily admitted psychiatric service users. We found that individuals who had been admitted involuntarily, who had a diagnosis of a psychotic disorder, and who reported higher levels of perceived pressures on admission were more likely to have a poorer therapeutic relationship with their consultant psychiatrist. Greater levels of insight and treatment satisfaction, together with higher levels of procedural justice experienced on admission, were associated with a better therapeutic relationship. We found that the level of perceived coercion on admission was not related to the therapeutic relationship. Targeted interventions to improve the therapeutic relationship, particularly for involuntarily admitted service users, are discussed.
The Journal of nervous and mental disease 03/2014; 202(3):186-92. DOI:10.1097/NMD.0000000000000102 · 1.69 Impact Factor
"Consistent with previous empirical literature on application of procedural justice theory to diversion programs (e.g., O'Keefe, 2006; Poythress et al., 2002; Tyler, 2006), two Likert-scale self-report measures were used to assess thematic components of procedural justice: the Perceptions of Procedural Justice (PPJ; Cascardi, Poythress, & Hall, 2000; Poythress et al., 2002) and the Impact of Hearing (IOH; adapted from Poythress et al., 2002). The MacArthur Admission Experience Survey: Short Form (MAES; Gardner et al., 1993) was also administered. On the PPJ, participants are asked to rate on a Likert scale the degree to which (1) they had an opportunity to tell the judge about their personal and legal circumstances, (2) they felt that the judge seemed genuinely interested in them as a person, (3) the judge treated them with respect, (4) the judge treated them fairly, (5) they were satisfied with how the judge treated them and dealt with their case, and (6) they were satisfied with the decisions made regarding their case. "
[Show abstract][Hide abstract] ABSTRACT: Internationally, one effort to reduce the number of people with serious mental illness (SMI) in jails and prisons is the development of Mental Health Courts (MHC). Research on MHCs to date has been disproportionately focused on the study of recidivism and re-incarceration over the potential of these problem-solving courts to facilitate mental health recovery and affect the slope or gradient of opportunity for recovery. Despite the strong conceptual links between the MHC approach and the recovery-orientation in mental health, the capacity for MHCs to facilitate recovery has not been explored. This user-informed mental health and criminal justice (MH/CJ) community based participatory (CBPR) study assesses the extent to which MHC practices align with recovery-oriented principles and may subsequently affect criminal justice outcomes. We report on the experiences and perceptions of 51 MHC participants across four metropolitan Mental Health Courts. Specifically, the current study assesses: 1) how defendants' perceptions of court practices, particularly with regard to procedural justice and coercion, relate to perceptions of mental health recovery and psychiatric symptoms, and, 2) how perceptions of procedural justice and mental health recovery relate to subsequent criminal justice outcomes. The authors hypothesized that perceived coercion and mental health recovery would be inversely related, that perceived coercion would be associated with worse criminal justice outcomes, and perceptions of mental health recovery would be associated with better criminal justice outcomes. Results suggest that perceived coercion in the MHC experience was negatively associated with perceptions of recovery among MHC participants. Perceptions of "negative pressures," a component of coercion, were important predictors of criminal justice involvement in the 12 month period following MHC admission, even when controlling for other factors that were related to criminal justice outcomes, and that an increase in procedural justice was associated with a decrease in symptoms but curiously not to an increase in attitudes toward recovery. Implications and future directions are discussed.
International Journal of Forensic Mental Health 04/2013; 12(2):116-125. DOI:10.1080/14999013.2013.791351 · 1.05 Impact Factor
"These items are scored to arrive at a global score of perceived coercion. The MPCS has been used in a variety of psychiatric settings (Rain et al., 2003) and has demonstrated psychometrically sound properties which are comparable to more lengthy interview-based measures of perceived coercion (Gardner et al., 1993). "
[Show abstract][Hide abstract] ABSTRACT: This study aims to investigate treatment drop-out, and the associated roles of motivation, alliance, and behaviour change exhibited over the first four weeks of hospitalised treatment for anorexia.
90 participants meeting DSM-IV criteria for anorexia nervosa completed questionnaires at admission, and four weeks into treatment. Weight data was collected over this same time period. At the end of treatment, participants were categorised into completer or premature termination groups.
The overall rate of premature termination was 57.8%. Those who prematurely terminated treatment demonstrated lower discharge BMI (p<.0005), and weight gain (p<.0005) than those who completed. Therapeutic alliance proved significantly different between outcome groups at admission (p=.004).
End-of-treatment outcomes for those who do not complete treatment are invariably poor. Therapeutic alliance appears to be a particularly important factor in this area.
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