Английская Википедия:Informal coercion
Шаблон:Involuntary treatment sidebar
In the context of a doctor–patient relationship, informal coercion is a social process where a healthcare profession tries to make a patient adhere to the healthcare system's desired treatment without making use of formal coercion such as involuntary commitment combined with involuntary treatment.[1]Шаблон:Rp An example of involuntary treatment in mental health care is intramuscular injection with the antipsychotic haloperidol.[2]Шаблон:Rp
Informal coercion is often applied by health professionals as part of mental health treatment but is also used by friends and family of a service user.[1]Шаблон:Rp
Classification
Several hierarchies of informal coercion have been created. Smuzkler and Appelbaum defined a five-level hierarchy of coercion:[1]Шаблон:Rp[3]Шаблон:Rp
- persuasion
- interpersonal leverage
- inducements
- threats
- compulsory treatment.
Lidz et al. define nine forms of informal coercion:
- persuasion
- inducement
- threats
- show of force
- physical force
- legal force
- request for a dispositional preference
- giving orders
- deception.
Interpersonal leverage
If the service user has an emotional dependency on the service provider then the clinician can use displays of disappointment to influence the service user.[1]Шаблон:Rp
Inducements
The patient may be demanded to do what a clinician wants to secure access to goods of monetary value such as housing, money, children, and criminal justice.[1]Шаблон:Rp Conditional access to housing is the most common form of inducement in informal coercion, being report by 15–40% of service users.[1]Шаблон:Rp A study of informal coercion in housing provision found that 60% of noncompliant service users were excluded from the program.[1]Шаблон:Rp Healthcare worker may use inducements such as cigarettes, drinks, or a walk to persuade patients to take medication.[4]Шаблон:Rp
Threats
The threat of involuntary commitment or involuntary treatment of treatment may be used to convince patients to comply without using formal coercion.[4]Шаблон:Rp
Prevalence
Studies show that most mental health professionals use informal coercion daily in routine practice.[1]Шаблон:Rp Practitioners use informal coercion more than they are aware, and a study showed it is underestimated.[1]Шаблон:Rp 29–59% of service users report informal coercion, according to studies spanning different regions.[1]Шаблон:Rp Judicial leverage, where a service user complies to treatment to avoid legal proceedings, was reported by 11–23% of service users.[1]Шаблон:Rp
Attitudes
55–69% of service users said they perceived interpersonal leverage as fair and 48–60% as effective. Studies show that patients with higher levels of insight were more favourable to coercion. Patients diagnosed with schizophrenia are more likely to say that informal coercion is taking place, and are more negative about its use.[1]Шаблон:Rp
Service providers, such as mental health nurses or psychiatrists, consider informal coercion as a means to promote compliance, which they felt could prevent worsening of symptoms and the need for formal coercion. Professionals felt that informal coercion could encourage individuals to take more agency over their lives.[1]Шаблон:Rp
In a focus group with international mental health care workers, workers were found to consider informal coercion effective, but were uneasy about its use.[5]Шаблон:Rp Healthcare workers felt informal coercion was more acceptable in cases of mania or acute psychosis.[5]Шаблон:Rp There was a degree of cognitive dissonance surrounding the practice, healthcare workers described behaviour matching formal definitions of informal coercion, but were reluctant to label their behaviour as coercive.[5]Шаблон:Rp
References
