ArticleBMC health services research2022
Persuasion or coercion? An empirical ethics analysis about the use of influence strategies in mental health community care.
Article in BMC health services research, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed, 19 citations in OpenAlex.
- Experiences of restrictive practices in child and adolescent mental health inpatient care: an integrative review.Child and adolescent psychiatry and mental health · 2026Review
- Augmenting research consent: should large language models (LLMs) be used for informed consent to clinical research?Research ethics · 2025Article
- Prevalence of Current Clinical Leverage and Association with Perceived Coercion in Outpatient and Community Psychiatric Settings: A First in Canada Study.Community mental health journal · 2025Article
- Users' Experience of Treatment and Coercion in an Inpatient Medium-Stay Psychiatric Rehabilitation Unit: A Mixed Methods Study.Journal of psychiatric and mental health nursing · 2025Article
- "I Do Not Believe We Should Disclose Everything to an Older Patient": Challenges and Ethical Concerns in Clinical Decision-Making in Old-Age Care in Ethiopia.Health care analysis : HCA : journal of health philosophy and policy · 2024Article
- Measurement of perceived pressures in psychiatry: paper-and-pencil and computerized adaptive version of the P-PSY35 scale.Annals of general psychiatry · 2024Article
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Authors and funding
2 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundInfluence strategies such as persuasion and interpersonal leverage are used in mental health care to influence patient behaviour and improve treatment adherence. One ethical concern about using such strategies is that they may constitute coercive behaviour ("informal coercion") and negatively impact patient satisfaction and the quality of care. However, some influence strategies may affect patients' perceptions, so an umbrella definition of "informal coercion" may be unsatisfactory. Furthermore, previous research indicates that professionals also perceive dissonance between theoretical explanations of informal coercion and their behaviours in clinical practice. This study analysed mental health professionals' (MHPs) views and the perceived ethical implications of influence strategies in community care.
methodsQualitative secondary data analysis of a focus group study was used to explore the conflict between theoretical definitions and MHPs' experiences concerning the coerciveness of influence strategies. Thirty-six focus groups were conducted in the main study, with 227 MHPs from nine countries participating.
resultsThe findings indicate that not all the influence strategies discussed with participants can be defined as "informal coercion", but they become coercive when they imply the use of a lever, have the format of a conditional offer and when the therapeutic proposal is not a patient's free choice but is driven by professionals. MHPs are rarely aware of these tensions within their everyday practice; consequently, it is possible that coercive practices are inadvertently being used, with no standard regarding their application. Our findings suggest that levers and the type of leverage used in communications with the patient are also relevant to differentiating leveraged and non-leveraged influence.
conclusionOur findings may help mental health professionals working in community care to identify and discuss influence strategies that may lead to unintended coercive practices.
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