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PubMed1993

Coercion and legal protection in psychiatric care in Finland.

In this article an overview is given on the complexity of coercion and legal protection in psychiatric care. The Finnish criteria for coercive treatment and some types of coercion are presented. The defining and classifying of mental illnesses are stated to be culturally bound, developing processes. How the incidence of involuntary care correlates with the number of hospital beds is discussed. Some suggestions to improve the legal protection of psychiatric patients in Finland are presented.

Behavior Control↗
PubMed1996

[The use of coercion at psychiatric departments for adults, Hillerød hospital. A descriptive study of the period 10 January 1991-31 August 1992].

The study describes the type and amount of coercion used during 11 months of 1992. Four hundred and fourty-one cases were included. Young patients i.e. 10 to 29 years old, demented patients and patients suffering from organic psychoses were, overall, more often subjected to coercive measures. When looking at each type of coercion separately, it was found that detainment, compulsive treatment and fixation were especially used on the young and on patients suffering from schizophrenia. However, fixation used as a protective measure was mainly used on the demented and the 60 to 79 year-old patients.

Adolescent↗
PubMed2003

Does fear of coercion keep people away from mental health treatment? Evidence from a survey of persons with schizophrenia and mental health professionals.

Mental health consumer advocates have long argued that involuntary treatment frightens persons with mental disorder and thus deters them from voluntarily seeking help. We surveyed 85 mental health professionals and 104 individuals with schizophrenia spectrum conditions to assess their experience with and perceptions of involuntary treatment and other treatment mandates. Of the clinicians, 78% reported that overall they thought legal pressures made their patients with schizophrenia more likely to stay in treatment. Regarding involuntary outpatient commitment, 81% of clinicians disagreed with the premise that mandated community treatment deters persons with schizophrenia from seeking voluntary treatment in the future. Of the consumer sample, 63% reported a lifetime history of involuntary hospitalization, while 36% reported fear of coerced treatment as a barrier to seeking help for a mental health problem-termed here "mandated treatment-related barriers to care." In bivariate analyses, reluctance to seek outpatient treatment associated with fear of coerced treatment (mandated treatment-related barriers to care) was significantly more likely in subjects with a lifetime history of involuntary hospitalization, criminal court mandates to seek treatment, and representative payeeship. However, experience with involuntary outpatient commitment was not associated with barriers to seeking treatment. Recent reminders or warnings about potential consequences of treatment nonadherence, recent hospitalization, and high levels of perceived coercion generally were also associated with mandated treatment-related barriers to care. In multivariable analyses, only involuntary hospitalization and recent warnings about treatment nonadherence were found to be significantly associated with these barriers. These results suggest that mandated treatment may serve as a barrier to treatment, but that ongoing informal pressures to adhere to treatment may also be important barriers to treatment.

Attitude of Health Personnel↗
PubMed2003

Waking Rip van Winkle: why developments in the last 20 years should teach the mental health system not to use housing as a tool of coercion.

Many housing programs for people with mental illnesses rely on models that require the person to adhere to treatment as a condition of continuing access to housing. These models that 'bundle' housing and treatment are relics of a past in which persons with mental illnesses were afforded little real choice in treatment, housing and other social supports. Conditioning access to housing in this manner is coercive and at odds with current thinking regarding treatment, as well as legal principles that shape the environment in which treatment is provided. This article summarizes the reasons why housing for people with mental illnesses should be provided free of the use of coercion.

Coercion↗
PubMed1995

Does sexual coercion play a role in the high-risk sexual behavior of adolescent and young adult women?

Sexual coercion and its relationship to high-risk sexual behavior were examined in five samples of young women. Sample 1 (N = 22) consisted of sexually active adolescents aged 15 to 19. Samples 2 (N = 206) and 3 (N = 70) were recruited from among patients at three sexually transmitted disease clinics. Sample 4 (N = 51) consisted of young homeless women living on the street in a large city. Sample 5 (N = 51) was recruited from among young women on a college campus. Across all samples, 44.4% of women indicated that they had been forced into some form of sexual activity against their will. Self-reports of sexually coercive experiences were consistently related to risky sexual behavior. It appears that many young women are coerced into engaging in high-risk sexual behavior. This implies the need for greater attention to male coercive sexual behavior and women's skills for coping with such behavior.

Adolescent↗
PubMed1995

Intimidation, coercion and resistance in the final stages of the South Asian Smallpox Eradication Campaign, 1973-1975.

This paper reviews episodes during 1973-1975 when American physician-epidemiologists in South Asia, working under the auspices of the World Health Organization, intimidated local health officials and resorted to coercive methods in the final stages of the Smallpox Eradication Programme. While intimidation and coercion were successful in the short-run in ensuring disease containment, they evoked health-professional and popular resentments, and the long-term effect may have been to foster negative attitudes toward subsequent vaccination campaigns. At the very least these episodes suggest a need for paying attention to actual and perceived abuses when global health measures are introduced from 'above' into regional settings.

Asia↗
PubMed2005

Conversational silence, coercion, equality: the role of language in influencing who gets identified as abused.

Various methods of ascertaining self-reported exposure to intimate partner violence (IPV) in health care and research settings have been evaluated to identify women who interpret themselves as abused for clinical and research intervention. However, few interpretive frameworks have been proposed to explain factors that may influence the success of this ascertainment process, including the contribution of language in facilitating women's interpretations of situations as abusive across social, cultural and historical contexts. This omission is substantial, given that IPV is context-specific, involving interaction between individuals of diverse linguistic and cultural backgrounds and their sociocultural environment. In the first part of this paper, we outline hermeneutics, one interpretive theoretical tradition to describe approaches to interpreting IPV. Hermeneutics is a linguistic philosophy that focuses on questions of how people understand spoken language, written text, and themselves through language across sociocultural environments. Hermeneutics acknowledges conditions and situations that facilitate opportunities for broad shared understanding and vocabularies about violence between communities, professionals and abused women, which in turn may reduce harm to women and negotiate action women may want to take in response to situations they interpret as abusive. In the second and third parts of the paper, we compare and contrast the strengths and limitations of three common approaches for asking women about IPV in health care and research settings, and outline a multi-dimensional IPV ascertainment tool that incorporates the three asking approaches to facilitate professionals bringing broad definitions of and vocabularies about abuse to encounters with women. This paper provides health care researchers, clinicians and policy makers with a framework for understanding the potential influence of language on women's interpretations of IPV, including the role of community and professional conversational silence, coercion and equality in influencing women's interpretations. We look at the influence of language about intimate partner violence in the United States on women's interpretations of abuse, although the basic constructs presented here could be applied in other countries and settings.

Coercion↗
PubMed2002

The epidemiology of rape and sexual coercion in South Africa: an overview.

During 1999 the issue of rape in South Africa was debated at the highest levels. The epidemiology of rape has become an issue of considerable political importance and sensitivity, with President Mbeki demanding an answer to the question: how much rape is there in South Africa? The purpose of this paper is both to summarise and synthesise the findings of research to provide an overview of the epidemiology of rape of women in South Africa and to show how difficult it is to answer the President's question. The review begins by considering why rape is so difficult to research. Data available shows that rape reported to the police (240 incidents of rape and attempted rape per 100,000 women each year) represents the tip of an ice berg of sexual coercion. Representative community-based surveys have found, for example, that in the 17-48 age group there are 2070 such incidents per 100,000 women per year. Non-consensual sex in marriage and dating relationships is believed to be very common but is usually not well reported in surveys. Forced sexual initiation is reported by almost a third of adolescent girls. In addition coerced consensual sex is a common problem in schools, workplaces and amongst peers. Knowledge of causal and contributory factors influencing the high levels of rape are also discussed. We conclude that the rape statistic for the country is currently elusive but levels of non-consensual and coerced sex are clearly very high. International comparison needs to be approached with caution because most developing countries lack the infrastructure for accurate crime reporting and do not have such a substantial body of survey data.

Adolescent↗
PubMed2002

Sexual coercion among adolescent women seeking abortion in China.

PURPOSE: To probe the backgrounds and reasons of sexual coercion (SC) among the adolescent abortion-seekers in China. METHODS: In this case-control study, we considered the abortion-seeking women (1,137) who reported that they had ever experienced SC as "case group" and we considered the abortion-seeking women (1,246) who reported that they had never experienced SC as "control group." We compared the differences in demographic characteristics, some relevant factors (e.g., abusing alcohol, multiple sex partners, etc.). We used OR as a criterion to measure the relative risk (that is, the strength of association between these factors and SC). RESULTS: The factors that were more likely to be associated with SC included: poor education (OR, 1.51), beaten by her partner (OR, 3.70), multiple sex partners (OR, 2.93), sex after abusing alcohol (OR, 6.45), selling sex for money (OR, 17.07), having sex for material benefits (OR, 11.68), sex owing to watching pornographic videotape (OR, 3.88), younger age (<18 years) at first intercourse (OR, 1.92), and larger age difference (>5 years) between male and female partners (OR, 1.34). CONCLUSIONS: The rate of SC among Chinese adolescent women seeking abortion is rather high, and SC is associated with many factors.

Abortion, Induced↗
PubMed1997

Understanding sexual coercion among young adolescents: communicative clarity, pressure, and acceptance.

Young people's understanding of sexual coercion was studied. Boys and girls (N = 191) were asked to rate scenarios depicting sexual situations according to their perceptions of communicative clarity, the extent of pressure being applied to one partner, and the acceptability of the behaviors. Judgments of communicative clarity were given more readily when there was consent rather than dissent to sex. Clear communication was readily inferred even when there were no cues that this was the case. Boundaries of behaviors that were defined as constituting "pressure" were influenced by the outcome, that is whether sex did or did not occur, as well as the behavior itself. Ratings of acceptability closely followed those of pressure, although the relationships between perceptions of pressure and acceptability were stronger for girls than for boys. In general, there were few gender differences in perceptions of pressure and communicative clarity. Of concern was the finding that, for some respondents, pressure and acceptability were unrelated to the use of either physical or emotional force.

Adolescent↗
PubMed2004

Clarifying parent-child reciprocities during early childhood: the early childhood coercion model.

Consistent with existing theory, the quality of parent-child interactions during early childhood affects children's social relationships and behavioral adjustment during middle childhood and adolescence. Harsh parenting and a propensity toward emotional overarousal interact very early in life to affect risk for later conduct problems. Less empirical work has evaluated the emergence of early childhood coercive parent-child reciprocities. The proposed early childhood coercion model describes the processes by which coercive parent-child reciprocities emerge. Specifically, the interaction between parenting and infants' propensities toward reactivity influences the development of emotion regulation in children and disciplinary styles in parents. Highly reactive children are expected to experience more difficulty learning to regulate emotions and to evoke harsher parenting. Through a process of mutual reinforcement, harsh parenting, negative emotional reactivity, and poor emotion regulation become coercive parent-child reciprocities during early childhood. The emergence of coercive parent-child interactions further diminishes children's emotional regulatory capacities and affects the formation of peer relationships during kindergarten.

Adult↗
PubMed2004

A woman's choice? On women, assisted reproduction and social coercion.

This paper critically discusses an argument that is sometimes pressed into service in the ethical debate about the use of assisted reproduction. The argument runs roughly as follows: we should prevent women from using assisted reproduction techniques, because women who want to use the technology have been socially coerced into desiring children--and indeed have thereby been harmed by the patriarchal society in which they live. I call this the argument from coercion. Having clarified this argument, I conclude that although it addresses important issues, it is highly problematic for the following reasons. First, if women are being coerced to desire to use AR, we should eradicate the coercive elements in pro-natalist ideology, not access to AR. Second, the argument seems to have the absurd implication that we should prevent all women, whether fertile or not, to try to have children. Third, it seems probable that women's welfare will be greater if we let well informed and decision-competent women decide for themselves whether they want to use AR.

Coercion↗
PubMed2000

Managing protest behaviour: from coercion to compassion.

The compulsory detention and involuntary treatment of mentally disordered offenders is fraught with conceptual difficulties relating to liberty and the protection of others from harm. It is often the case in forensic psychiatry that patients consider themselves unjustly treated and unfairly judged, which may result in some engaging in protest behaviour. This paper is concerned with setting out some philosophical positions in relation to such loss of liberty and forced treatment, and views the protest scenario as a form of hostage situation. This perspective shifts the management of protest behaviour from strategies of coercion to those based on negotiation. Finally, four models of management are set out to facilitate the understanding of protest, and these refer to: (a) crisis bargaining by tracking relational paradox; (b) negotiation as psychotherapy; (c) bio-behavioural dimension; and (d) protest as post-traumatic stress disorder.

Coercion↗
PubMed2003

Influence and coercion: relational and rights-based ethical approaches to forced psychiatric treatment.

The dominant rights-based approach to the ethics of coercion in psychiatric treatment guides clinicians in deciding whether treatment should be compelled or the patient's autonomy respected, but provides no guidance across the remaining broad continuum of influence that clinicians exert with patients. The assumptions of the rights-based approach lead to three dichotomous decisions: (1) 'Is the treatment voluntary?'; (2) 'Is the patient competent?' and (3) 'Are the consequence of no treatment dangerous?'. The assumptions of a relational approach lead to ethical guidance across the full range in the intensity and types of influence which may be ethically justified or required in psychiatric treatment. These assumptions are: (1) influence is inherent in the clinical relationship; (2) the relevant factors are continuous and (3) all decisions are subjective. While the rights-approach emphasizes defining competence and developing techniques to predict future patient dangerousness, the relational approach emphasizes patient-clinician responsibilities in ethical relationships and understanding all factors which legitimately bear on the use of influence. An initial list of such factors is offered.

Coercion↗
PubMedDate not supplied

Narrative constructions of sexual violence as told by female rape survivors in three populations of the southwestern United States: scripts of coercion, scripts of consent.

There is a growing literature on the narrative construction of rape as sexual violence. This is puzzling, since, in certain contexts, violence may stifle narrative production. Researchers of atrocities, for example, propose that the experience of recurring terror disrupts narrative cohesion in reporting lived trauma. Genocidal horror occurs in the context of communities and ethnic groups. Our rape survival data from women of three populations in the southwestern United States reflect traumas of sexual violence against women, experienced within everyday lives. From interviews with 62 female rape survivors, we (1) identify narrative conventions and linguistic devices to show how these women structure accounts of sexual assault that reflect their cultural background; (2) contrast scripts of coercion and consent; (3) examine how the way in which these women describe the coercive actions of the perpetrator(s) contradicts the assumptions of legal discourse; and (4) discuss the narrative production of several women in abusive relationships and compare it to the narrative production (or lack thereof) of persons who experience state-engineered terror.

Adolescent↗
PubMedDate not supplied

Criminal justice coercion in the treatment of alcohol problems: an examination of two client subgroups.

An increasing number of individuals are being referred to alcohol treatment programs under coercion from the criminal justice system. While a substantial number of investigations have addressed coercive treatment for illicit drug-related offenses, fewer studies have focused on mandated treatment for alcohol-related problems. This article examines the treatment of two subgroups of clients coerced into alcohol treatment from criminal justice institutions. The article begins with an overview of the literature on clients coerced into treatment as a result of "driving under the influence" (DUI) charges. The characteristics of a subgroup that has received less attention are then described: lower socioeconomic clients who are coerced into alcohol treatment from the courts for non-DUI offenses, such as public inebriation, disorderly conduct, trespassing, assault, and theft. This subgroup of non-DUI coerced-treatment offenders depends primarily upon underfunded public services, although their treatment requires careful assessment and triage for multiple problem areas. The article addresses some potential political and economic roadblocks to comprehensive treatment and closes with questions and recommendations for further research.

Alcoholism↗
PubMed2005

The use of legal coercion in the treatment of substance abusers: an overview and critical analysis of thirty years of research.

Drug and alcohol use presents a serious social problem for most countries in the world. Of particular concern is the well-documented relationship between substance use and crime, which has contributed to an increased popularity and willingness to utilize more forceful means to pressure substance users into treatment. Although compulsory/legally mandated treatment is appealing, it has been one of the most fiercely debated topics in the addiction field, raising a number of issues including ethical concerns and motivational considerations. In this context, the most important question to be answered is whether or not compulsory treatment is effective in the rehabilitation of addicted offenders. Regrettably, three decades of research into the effectiveness of compulsory treatment have yielded a mixed, inconsistent, and inconclusive pattern of results, calling into question the evidence-based claims made by numerous researchers that compulsory treatment is effective in the rehabilitation of substance users. The present paper provides an overview of the key issues concerning the use and efficacy of legal coercion in the rehabilitation of substance users, including a critique of the research base and recommendations for future research.

Australia↗
PubMed2001

Coercion and drug treatment for postpartum women.

This research examined the extent to which various indicators of coercion were related to treatment retention in a gender-specific treatment program and a traditional outpatient program for pregnant and postpartum women who were mandated to enter treatment. Women who were given custody of their infant stayed in treatment longer than women who did not have custody. There was an interaction effect with women who had custody and were in the intensive day treatment program completing treatment at a much higher rate than those in the traditional program. Implications for social work professionals and policy makers are discussed.

Adolescent↗