Cw. Lidz et al., FACTUAL SOURCES OF PSYCHIATRIC-PATIENTS PERCEPTIONS OF COERCION IN THE HOSPITAL ADMISSION PROCESS, The American journal of psychiatry, 155(9), 1998, pp. 1254-1260
Objective: The purpose of this study was to determine what predicts pa
tients' perceptions of coercion surrounding admission to a psychiatric
hospital. Method: For 171 cases, the authors integrated data from int
erviews with patients, admitting clinicians, and other individuals inv
olved in the patients' psychiatric admissions with data from the medic
al records. Using a structured set of procedures, coders determined wh
ether or not nine coercion-related behaviors occurred around the time
of admission. Correlation and regression analyses were used to describ
e the predictors of: patients' scores on the MacArthur Perceived Coerc
ion Scale. Results: The use of legal force, being given orders, threat
s, and ''a show of force'' were all strongly correlated with perceived
coercion. A least squares regression accounted for 43.3% of the Varia
nce in perceived coercion. The evidence also suggested that force is t
ypically only used in conjunction with less coercive pressures. Conclu
sions: Force and negative symbolic pressures, such as threats and givi
ng orders about admission decisions, induce perceptions of coercion in
persons with mental illness. Positive symbolic pressures, such as per
suasion, do not induce perceptions of coercion. Such positive pressure
s should be tried in order to encourage admission before force or nega
tive pressures are used.