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Perception and use of informal coercion in outpatient treatment: a focus group study with mental health professionals of Latin culture.

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Title: Perception and use of informal coercion in outpatient treatment: a focus group study with mental health professionals of Latin culture.
Authors: García-Cabeza, Ignacio1 igcabeza@salud.madrid.org, Valenti, Emanuel2, Calcedo, Alfredo1
Source: Salud Mental. mar/abr2017, Vol. 40 Issue 2, p63-69. 7p.
Subjects: OUTPATIENT medical care, MENTAL health personnel, AUTONOMY (Philosophy), MENTAL health services, PERSUASION (Psychology), PATIENT compliance
Abstract (English): Introduction. In addition to compulsion (involuntary hospitalization, seclusion, restraint, etc.), there are broader forms of coercion (persuasion, interpersonal pressure, inducement or threat), called informal or covert coercion, all of which try to improve patients adherence to treatment. Objective. To analyse the use of covert coercion in mental health outpatients and the mental health professionals' views on this practice comparing four countries (Spain, Italy, Mexico and Chile). Methods. We conducted a qualitative research using four focus groups in each country with mental health professionals working in mental health centres and based on a thematic analysis approach. Sample. The total sample was made up of 98 professionals (31 psychiatrists, 25 clinical psychologists, 28 nurses, eight social workers and six other professionals). Results. The use of informal coercion was recognized in clinical practice, but its intensity was related to professionals' characteristics and to factors related to diagnosis, clinical course, perceived risk, insight, therapeutic relationship and organizational issues in the delivery of services. Its use was justified by effectiveness in improving adherence and, generally, in seeking benefits for the patient, but sometimes in a paternalistic way. Discussion and conclusion. Our results match those described in the literature in terms of: 1. sociodemographic and clinical profile; 2. the reason that leads to its use (adherence); 3. ethical justification (search for patient's benefit, trying not to impair his freedom); hence, the most intense forms (threat) were misperceived. Our professionals acknowledged the use of covert coercion in their clinical practice, justifying it on ethical and clinical grounds. [ABSTRACT FROM AUTHOR]
Abstract (Spanish): Introducción. Además de la coerción formal (hospitalización involuntaria, contención, etc.), en salud mental existen otras formas de coerción (persuasión, presión interpersonal, inducción o amenaza), denominada informal o encubierta, que pretenden mejorar la adherencia. Objetivo. Conocer el uso de la coerción informal en el tratamiento ambulatorio de enfermos mentales y la percepción que de ella tienen los profesionales de salud mental de cuatro países (España, Italia, México y Chile). Método. Utilizamos una investigación cualitativa con cuatro grupos focales por país, compuestos por profesionales que trabajaban en centros de salud mental, con un enfoque basado en el análisis temático. La muestra fue de 98 profesionales (31 psiquiatras, 25 psicólogos clínicos, 28 enfermeros, ocho trabajadores sociales y otras seis profesiones). Resultados. Se reconoció el uso de la coerción informal en la práctica clínica. Su intensidad dependió de características del profesional y factores relacionados con el diagnóstico, clínica, evolución de la enfermedad, peligrosidad del paciente, conciencia de enfermedad, relación terapéutica y aspectos organizativos asistenciales. Su uso se justificó por la eficacia y la búsqueda de beneficios para el paciente, a veces de forma paternalista. Discusión y conclusión. Nuestros resultados coincidieron en cuanto al perfil sociodemográfico y clínico con lo descrito en la bibliografía. También lo hicieron en cuanto al motivo que lleva a su uso (la adherencia) y su justificación ética (la búsqueda del beneficio del paciente menoscabando su libertad lo menos posible), de ahí que las formas más intensas (amenaza) fueron mal percibidas. Nuestros profesionales reconocieron el ejercicio de la coerción encubierta en su práctica habitual, justificándola clínica y éticamente. [ABSTRACT FROM AUTHOR]
Copyright of Salud Mental is the property of Instituto Nacional de Psiquiatria Ramon de la Fuente and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: MedicLatina
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  Data: Perception and use of informal coercion in outpatient treatment: a focus group study with mental health professionals of Latin culture.
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  Data: <searchLink fieldCode="AR" term="%22García-Cabeza%2C+Ignacio%22">García-Cabeza, Ignacio</searchLink><relatesTo>1</relatesTo><i> igcabeza@salud.madrid.org</i><br /><searchLink fieldCode="AR" term="%22Valenti%2C+Emanuel%22">Valenti, Emanuel</searchLink><relatesTo>2</relatesTo><br /><searchLink fieldCode="AR" term="%22Calcedo%2C+Alfredo%22">Calcedo, Alfredo</searchLink><relatesTo>1</relatesTo>
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  Data: <searchLink fieldCode="JN" term="%22Salud+Mental%22">Salud Mental</searchLink>. mar/abr2017, Vol. 40 Issue 2, p63-69. 7p.
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  Data: <searchLink fieldCode="DE" term="%22OUTPATIENT+medical+care%22">OUTPATIENT medical care</searchLink><br /><searchLink fieldCode="DE" term="%22MENTAL+health+personnel%22">MENTAL health personnel</searchLink><br /><searchLink fieldCode="DE" term="%22AUTONOMY+%28Philosophy%29%22">AUTONOMY (Philosophy)</searchLink><br /><searchLink fieldCode="DE" term="%22MENTAL+health+services%22">MENTAL health services</searchLink><br /><searchLink fieldCode="DE" term="%22PERSUASION+%28Psychology%29%22">PERSUASION (Psychology)</searchLink><br /><searchLink fieldCode="DE" term="%22PATIENT+compliance%22">PATIENT compliance</searchLink>
– Name: Abstract
  Label: Abstract (English)
  Group: Ab
  Data: Introduction. In addition to compulsion (involuntary hospitalization, seclusion, restraint, etc.), there are broader forms of coercion (persuasion, interpersonal pressure, inducement or threat), called informal or covert coercion, all of which try to improve patients adherence to treatment. Objective. To analyse the use of covert coercion in mental health outpatients and the mental health professionals' views on this practice comparing four countries (Spain, Italy, Mexico and Chile). Methods. We conducted a qualitative research using four focus groups in each country with mental health professionals working in mental health centres and based on a thematic analysis approach. Sample. The total sample was made up of 98 professionals (31 psychiatrists, 25 clinical psychologists, 28 nurses, eight social workers and six other professionals). Results. The use of informal coercion was recognized in clinical practice, but its intensity was related to professionals' characteristics and to factors related to diagnosis, clinical course, perceived risk, insight, therapeutic relationship and organizational issues in the delivery of services. Its use was justified by effectiveness in improving adherence and, generally, in seeking benefits for the patient, but sometimes in a paternalistic way. Discussion and conclusion. Our results match those described in the literature in terms of: 1. sociodemographic and clinical profile; 2. the reason that leads to its use (adherence); 3. ethical justification (search for patient's benefit, trying not to impair his freedom); hence, the most intense forms (threat) were misperceived. Our professionals acknowledged the use of covert coercion in their clinical practice, justifying it on ethical and clinical grounds. [ABSTRACT FROM AUTHOR]
– Name: Abstract
  Label: Abstract (Spanish)
  Group: Ab
  Data: Introducción. Además de la coerción formal (hospitalización involuntaria, contención, etc.), en salud mental existen otras formas de coerción (persuasión, presión interpersonal, inducción o amenaza), denominada informal o encubierta, que pretenden mejorar la adherencia. Objetivo. Conocer el uso de la coerción informal en el tratamiento ambulatorio de enfermos mentales y la percepción que de ella tienen los profesionales de salud mental de cuatro países (España, Italia, México y Chile). Método. Utilizamos una investigación cualitativa con cuatro grupos focales por país, compuestos por profesionales que trabajaban en centros de salud mental, con un enfoque basado en el análisis temático. La muestra fue de 98 profesionales (31 psiquiatras, 25 psicólogos clínicos, 28 enfermeros, ocho trabajadores sociales y otras seis profesiones). Resultados. Se reconoció el uso de la coerción informal en la práctica clínica. Su intensidad dependió de características del profesional y factores relacionados con el diagnóstico, clínica, evolución de la enfermedad, peligrosidad del paciente, conciencia de enfermedad, relación terapéutica y aspectos organizativos asistenciales. Su uso se justificó por la eficacia y la búsqueda de beneficios para el paciente, a veces de forma paternalista. Discusión y conclusión. Nuestros resultados coincidieron en cuanto al perfil sociodemográfico y clínico con lo descrito en la bibliografía. También lo hicieron en cuanto al motivo que lleva a su uso (la adherencia) y su justificación ética (la búsqueda del beneficio del paciente menoscabando su libertad lo menos posible), de ahí que las formas más intensas (amenaza) fueron mal percibidas. Nuestros profesionales reconocieron el ejercicio de la coerción encubierta en su práctica habitual, justificándola clínica y éticamente. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
  Group: Ab
  Data: <i>Copyright of Salud Mental is the property of Instituto Nacional de Psiquiatria Ramon de la Fuente and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.17711/SM.0185-3325.2017.009
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