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The relationship between mandated community treatment and perceived barriers to care in persons with severe mental illness.

Publication ,  Journal Article
Van Dorn, RA; Elbogen, EB; Redlich, AD; Swanson, JW; Swartz, MS; Mustillo, S
Published in: Int J Law Psychiatry
2006

OBJECTIVE: In recent decades debate has intensified over both the ethics and effectiveness of mandated mental health treatment for persons residing in the community. Perceived barriers to care among persons subjected to mandated community treatment, and the possibility that fear of involuntary treatment may actually create or strengthen such barriers rather than dissolve them, are key issues relevant to this debate but have been little studied. This article explores the link between receipt of mandated (or "leveraged") community treatment and reasons for avoiding or delaying treatment reported by persons with severe mental illness. It also examines the potential moderating effect of social support on the association between mandated treatment experiences and barriers attributable to fear of involuntary commitment or forced treatment. METHOD: Data are presented from a survey of 1011 persons with psychiatric disorders being treated in public-sector mental health service systems in five U.S. cities. Logistic and negative binomial regression analyses were used to examine the association between mandated community treatment and perceptions of barriers to care, controlling for demographic and clinical characteristics. RESULTS: Across sites, 32.4% to 46.3% of respondents reported barriers attributed to fear of forced treatment. Whereas 63.7% to 76.1% reported at least one non-mandate-related barrier to care; the mean number of non-mandated barriers to care ranged from 1.6 to 2.3 (range 0-7). Between 44.1% and 59.0% of participants had experienced at least one type of leveraged treatment. Persons experiencing multiple forms of mandated treatment were more likely to report barriers to care in comparison to those not reporting mandated treatment. Findings also indicated that social support moderates the relationship between multiple leverages (three or four forms) and mandate-related barriers to care. CONCLUSIONS: Perceived barriers to care associated with mandated treatment experience have the potential to adversely affect both treatment adherence and therapeutic alliance. Awareness of potential barriers to care and how they interact with patients' perceived social support may lead to improved outcomes associated with mandated treatment.

Duke Scholars

Published In

Int J Law Psychiatry

DOI

ISSN

0160-2527

Publication Date

2006

Volume

29

Issue

6

Start / End Page

495 / 506

Location

Netherlands

Related Subject Headings

  • Social Support
  • Severity of Illness Index
  • Psychology
  • North Carolina
  • Middle Aged
  • Mental Disorders
  • Massachusetts
  • Mandatory Programs
  • Male
  • Illinois
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Van Dorn, R. A., Elbogen, E. B., Redlich, A. D., Swanson, J. W., Swartz, M. S., & Mustillo, S. (2006). The relationship between mandated community treatment and perceived barriers to care in persons with severe mental illness. Int J Law Psychiatry, 29(6), 495–506. https://doi.org/10.1016/j.ijlp.2006.08.002
Van Dorn, Richard A., Eric B. Elbogen, Allison D. Redlich, Jeffrey W. Swanson, Marvin S. Swartz, and Sarah Mustillo. “The relationship between mandated community treatment and perceived barriers to care in persons with severe mental illness.Int J Law Psychiatry 29, no. 6 (2006): 495–506. https://doi.org/10.1016/j.ijlp.2006.08.002.
Van Dorn RA, Elbogen EB, Redlich AD, Swanson JW, Swartz MS, Mustillo S. The relationship between mandated community treatment and perceived barriers to care in persons with severe mental illness. Int J Law Psychiatry. 2006;29(6):495–506.
Van Dorn, Richard A., et al. “The relationship between mandated community treatment and perceived barriers to care in persons with severe mental illness.Int J Law Psychiatry, vol. 29, no. 6, 2006, pp. 495–506. Pubmed, doi:10.1016/j.ijlp.2006.08.002.
Van Dorn RA, Elbogen EB, Redlich AD, Swanson JW, Swartz MS, Mustillo S. The relationship between mandated community treatment and perceived barriers to care in persons with severe mental illness. Int J Law Psychiatry. 2006;29(6):495–506.
Journal cover image

Published In

Int J Law Psychiatry

DOI

ISSN

0160-2527

Publication Date

2006

Volume

29

Issue

6

Start / End Page

495 / 506

Location

Netherlands

Related Subject Headings

  • Social Support
  • Severity of Illness Index
  • Psychology
  • North Carolina
  • Middle Aged
  • Mental Disorders
  • Massachusetts
  • Mandatory Programs
  • Male
  • Illinois