Consumer Perceptions of Assertive Community Treatment Interventions

Abstract

The issue of coercion in community-based mental health programs is frequently linked to the development of the Assertive Community Treatment (ACT) model. Sixty-five adults diagnosed with severe and persistent mental illness, participating in an ACT model program, completed measures that assessed elements of coercion and the perceived frequency of use of ACT staff therapeutic limit setting activities, as well as the relationships between coercion, empowerment, quality of life, and the working alliance. On average, participants did not perceive high degrees of coercion or negative pressures and did not feel excluded from the process of making decisions. On the continuum of restrictiveness of therapeutic limit setting activities, participants perceived staff to be using less restrictive therapeutic limit setting activities more frequently. Elements of perceived coercion and specific activities were negatively related to quality of life, sense of empowerment, and the working alliance.

Increased influence and collaboration: a qualitative study of patients’ experiences of community treatment orders within an assertive community treatment setting

“…Studies have reported that ACT providers sometimes use assertive and controlling techniques. However, supportive relationships and interpersonal influence have been described as the most frequently used mechanisms for promoting treatment goals [ 43 , 47 – 49 ]. As some other studies of ACT show, most participants in our study reported that motivational interventions, persuasion, verbal guidance, and education were more frequently used than threats and force [ 43 , 47 – 49 ].…”

‘It's unbelievably humiliating’—Patients' expressions of negative effects of coercion in mental health care

“…On the other hand, the scale has been adapted to outpatient treatment and CTO. The Perceptions of Mental Health Services Questionnaire (Tschopp, Berven, & Chan, 2011) and the MacArthur Modified Admission Experience Survey (Swartz et al, 2002) are two such adaptations. To rewrite items regarding the admission process to cover pressures and coercion in respect of outpatient treatment was not easy, and I find the results wordy, such as the item "I had more influence than anyone else on whether I went to the mental health center".…”

“…The MacArthur Admission Experience Scale has been subjected to two adaptations for outpatient care. One is a combination of adapted items from the Admission Experience Scale and the Therapeutic Limit-Setting Scale (Neale & Rosenheck, 2000), called the Perceptions of Mental Health Services Questionnaire (Tschopp et al, 2011). The other is the MacArthur Admission Experience Survey (Modified) (Swartz et al, 2002).…”

A Clinical Translation of the Research Article Titled “Measuring the Recovery Orientation of ACT”

“…Because these approaches to engagement and treatment are commonly used, ACT programs have been criticized for being paternalistic or even coercive (Anthony, Rogers, & Farkas, 2003; Dennis & Monahan, 1996; Gomory, 2001; Williamson, 2002). Prior research is mixed on the extent to which ACT teams provide services in a recovery oriented way (Kidd et al, 2010; Moser & Bond, 2009; Neale & Rosenheck, 2000; Rapp & Goscha, 2004; Tschopp, Berven, & Chan, 2011).…”