FACTUAL SOURCES OF PSYCHIATRIC-PATIENTS PERCEPTIONS OF COERCION IN THE HOSPITAL ADMISSION PROCESS

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.