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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 Coercion () is compelling a party to act in an involuntary manner by the use of threats, including threats to use force against a party. It involves a set of forceful actions which violate the free will of an individual in order to induce a des ...
such as
involuntary commitment Involuntary commitment, civil commitment, or involuntary hospitalization/hospitalisation is a legal process through which an individual who is deemed by a qualified agent to have symptoms of severe mental disorder is detained in a psychiatric hos ...
combined with
involuntary treatment Involuntary treatment (also referred to by proponents as assisted treatment and by critics as forced drugging) refers to medical treatment undertaken without the consent of the person being treated. Involuntary treatment is permitted by law in so ...
. An example of involuntary treatment in mental health care is
intramuscular injection Intramuscular injection, often abbreviated IM, is the injection of a substance into a muscle. In medicine, it is one of several methods for parenteral administration of medications. Intramuscular injection may be preferred because muscles hav ...
with the
antipsychotic Antipsychotics, also known as neuroleptics, are a class of psychotropic medication primarily used to manage psychosis (including delusions, hallucinations, paranoia or disordered thought), principally in schizophrenia but also in a range of ...
haloperidol Haloperidol, sold under the brand name Haldol among others, is a typical antipsychotic medication. Haloperidol is used in the treatment of schizophrenia, tics in Tourette syndrome, mania in bipolar disorder, delirium, agitation, acute psychosi ...
. Informal coercion is often applied by
health professional A health professional, healthcare professional, or healthcare worker (sometimes abbreviated HCW) is a provider of health care treatment and advice based on formal training and experience. The field includes those who work as a nurse, physician (suc ...
s as part of
mental health Mental health encompasses emotional, psychological, and social well-being, influencing cognition, perception, and behavior. It likewise determines how an individual handles Stress (biology), stress, interpersonal relationships, and decision-maki ...
treatment but is also used by friends and family of a service user.


Classification

Several hierarchies of informal coercion have been created. Smuzkler and Appelbaum defined a five-level hierarchy of coercion: # 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 Disappointment is the feeling of dissatisfaction that follows the failure of expectations or hopes to manifest. Similar to regret, it differs in that a person who feels regret focuses primarily on the personal choices that contributed to a ...
to influence the service user.


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. Conditional access to housing is the most common form of inducement in informal coercion, being report by 15–40% of service users. A study of informal coercion in housing provision found that 60% of noncompliant service users were excluded from the program. Healthcare worker may use inducements such as cigarettes, drinks, or a walk to persuade patients to take medication.


Threats

The threat of
involuntary commitment Involuntary commitment, civil commitment, or involuntary hospitalization/hospitalisation is a legal process through which an individual who is deemed by a qualified agent to have symptoms of severe mental disorder is detained in a psychiatric hos ...
or
involuntary treatment Involuntary treatment (also referred to by proponents as assisted treatment and by critics as forced drugging) refers to medical treatment undertaken without the consent of the person being treated. Involuntary treatment is permitted by law in so ...
of treatment may be used to convince patients to comply without using formal coercion.


Prevalence

Studies show that most mental health professionals use informal coercion daily in routine practice. Practitioners use informal coercion more than they are aware, and a study showed it is underestimated. 29–59% of service users report informal coercion, according to studies spanning different regions. Judicial leverage, where a service user complies to treatment to avoid legal proceedings, was reported by 11–23% of service users.


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 Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social w ...
are more likely to say that informal coercion is taking place, and are more negative about its use. 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 Agency may refer to: Organizations * Institution, governmental or others ** Advertising agency or marketing agency, a service business dedicated to creating, planning and handling advertising for its clients ** Employment agency, a business that ...
over their lives. In a
focus group A focus group is a group interview involving a small number of demographically similar people or participants who have other common traits/experiences. Their reactions to specific researcher/evaluator-posed questions are studied. Focus groups are ...
with international mental health care workers, workers were found to consider informal coercion effective, but were uneasy about its use. Healthcare workers felt informal coercion was more acceptable in cases of
mania Mania, also known as manic syndrome, is a mental and behavioral disorder defined as a state of abnormally elevated arousal, affect, and energy level, or "a state of heightened overall activation with enhanced affective expression together wi ...
or acute
psychosis Psychosis is a condition of the mind that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are incoherent speech and behavi ...
. There was a degree of
cognitive dissonance In the field of psychology, cognitive dissonance is the perception of contradictory information, and the mental toll of it. Relevant items of information include a person's actions, feelings, ideas, beliefs, values, and things in the environmen ...
surrounding the practice, healthcare workers described behaviour matching formal definitions of informal coercion, but were relunctant to label their behaviour as coercive.


References

{{Reflist Mental health Coercion Persuasion