Patient Experiences of Autonomy and Coercion While Receiving Legal Leverage in Forensic Assertive Community Treatment

Abstract

Legal leverage is broadly defined as the use of legal authority to promote treatment adherence. It is widely utilized within mental health courts, drug courts, mandated outpatient treatment programs, and other intervention strategies for individuals with mental illness or chemical dependency who have contact with the criminal justice system. Nonetheless, the ethics of using legal authority to promote treatment adherence remains a hotly debated issue within public and professional circles alike. While critics characterize legal leverage as a coercive form of social control that undermines personal autonomy, advocates contend that it supports autonomy because treatment strategies using legal leverage are designed to promote health and independence. Despite the controversy, there is little evidence regarding the impact of legal leverage on patient autonomy as experienced and expressed by patients themselves. This report presents findings from a qualitative study involving six focus groups with severely mentally ill outpatients who received legal leverage through three forensic assertive community treatment (FACT) programs in Northeastern, Midwestern, and West Coast cities. Findings are discussed in the context of the self-determination theory of human motivation, and practical implications for the use of legal leverage are considered.

Therapeutic Social Control of People with Serious Mental Illness: An Empirical Verification and Extension of Theory

“…Throughout the history of Western society, people with psychiatric problems have been detained against their will for long periods of time and forced to undergo painful and invasive procedures (Deutsch 1949;Foucault 1965;Goffman 1961). Although laws intending to protect the rights of people with mental illness have been enacted, involuntary commitment to institutions, aggressive community treatment, forced medication compliance, and coerced electroconvulsive therapy still threaten the freedom and autonomy of this population (Berg and Bonnie 1996;Burstow 2006;Lamberti et al 2014;Miller and Hanson 2016;Solomon 1996). People with SMI are one of the few remaining groups who may be legally denied their basic human rights.…”

“…Moreover, professional standards of conduct require that clinicians weigh the principles of autonomy and justice in equal measure with the principles of beneficence and non-maleficence, and federal law mandates that all patients must be informed of their right to refuse treatment (Medical Professionalism Project 2002). However, some argue that exerting social control over people with SMI ultimately promotes autonomy because engagement in treatment leads to improved functioning and the ability to live independently (Lamberti et al 2014).…”

Psychological Distress Among Youth Probationers: Using Social Determinants of Health to Assess Suicidal Thoughts and Behaviors

“…Recent literature about adults suggests that interactions with the criminal justice system might provide legal leverage to help people in need of services link with care (Lamberti et al ., 2014). Court ordered treatment can move an individual from coercive control to intrinsic motivation (Kothari, Butkiewicz, Williams, Jacobson, Morse, & Cerulli, 2014; Morse, Cerulli, Bedell et al ., 2014).…”

“…Court ordered treatment can move an individual from coercive control to intrinsic motivation (Kothari, Butkiewicz, Williams, Jacobson, Morse, & Cerulli, 2014; Morse, Cerulli, Bedell et al ., 2014). It is possible that probation can become that legal leverage youth need to connect to care and begin seeing their behavior through a different lens (Lamberti et al ., 2014). Perhaps, their behaviors are not because they are “bad kids” with hopeless futures, but rather their behaviors are the result of emotional dysregulation, attachment issues, and their ACEs.…”

Diversion at re‐entry using criminogenic CBT: Review and prototypical program development

“…For instance, forensic assertive community treatment (FACT), an offshoot of the assertive community treatment (ACT) movement, seeks to improve outcomes for justice-involved clients with severe mental illness through collaboration between mental health treatment providers and criminal justice agencies, such as probation and parole (Lamberti, Deem, Weisman, & LaDuke, 2011). Such partnerships promote treatment adherence via legal influence and provide criminal justice agencies with access to rehabilitative alternatives to standard sanctions (Lamberti et al, 2011(Lamberti et al, , 2014. Although there are differences between individual programs (e.g., whether they admit individuals with who have committed certain types of offenses), there is also significant common ground (Lamberti et al, 2011).…”