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Leverage and other informal pressures in community psychiatric services in England: what can patients’ experiences add to our understanding?

Leverage and other informal pressures in community psychiatric services in England: what can patients’ experiences add to our understanding?
Leverage and other informal pressures in community psychiatric services in England: what can patients’ experiences add to our understanding?
Purpose

Informal practices aimed at managing psychiatric patients in the community setting fall outside legal and policy provision or guidance. “Leverage” is an informal practice whereby practitioners attempt to influence patients' treatment adherence by, for example, making patients' access to subsidised housing conditional upon adherence to treatment or by making treatment adherence a condition of patients' avoidance of financial control. Lower rates of leverage are reported in the UK compared to the USA, possibly due to differences between the US and European social welfare systems. These differences raise questions as to the international comparability of leverage practices described in the literature. The study aimed to capture patients' experiences and perceptions of pressures and to explore (a) whether “leverage” can be distinguished from other pressures, and (b) how a concept of leverage derived from patient experiences in England might fit with the literature to date. In this article we present the different types of pressure that we identified from patients' accounts, and a set of criteria derived for the purpose of distinguishing between these different types of pressure.

Method

Twenty-nine qualitative interviews with a purposive subsample from a study of leverage in the English mental health system were analysed.

Results

Participants reported a range of what can be classified as both leveraged and non-leveraged pressures. These were perceived as pressures to adhere to treatment, as well as “staying well.” Leveraged pressures were distinguishable from non-leveraged pressures by the presence of three features: conditionality, a lever and direct communication.

Conclusions

The portrayal of “leverage” in the current literature does not fully capture patient experiences of pressure. Our analysis offers a clearer concept of leverage and other pressures that influence patients, and which may have different legal, ethical and clinical implications.
0160-2527
100-106
Canvin, K.
b972afd2-1dd9-4fb4-ac79-2e39eb393237
Rugkåsa, J.
aba777de-90dd-4474-a810-152e447bc8c3
Sinclair, J.
be3e54d5-c6da-4950-b0ba-3cb8cdcab13c
Burns, T.
f570817b-410b-491a-a4d1-ed943149ef6b
Canvin, K.
b972afd2-1dd9-4fb4-ac79-2e39eb393237
Rugkåsa, J.
aba777de-90dd-4474-a810-152e447bc8c3
Sinclair, J.
be3e54d5-c6da-4950-b0ba-3cb8cdcab13c
Burns, T.
f570817b-410b-491a-a4d1-ed943149ef6b

Canvin, K., Rugkåsa, J., Sinclair, J. and Burns, T. (2013) Leverage and other informal pressures in community psychiatric services in England: what can patients’ experiences add to our understanding? International Journal of Law and Psychiatry, 36, 100-106.

Record type: Article

Abstract

Purpose

Informal practices aimed at managing psychiatric patients in the community setting fall outside legal and policy provision or guidance. “Leverage” is an informal practice whereby practitioners attempt to influence patients' treatment adherence by, for example, making patients' access to subsidised housing conditional upon adherence to treatment or by making treatment adherence a condition of patients' avoidance of financial control. Lower rates of leverage are reported in the UK compared to the USA, possibly due to differences between the US and European social welfare systems. These differences raise questions as to the international comparability of leverage practices described in the literature. The study aimed to capture patients' experiences and perceptions of pressures and to explore (a) whether “leverage” can be distinguished from other pressures, and (b) how a concept of leverage derived from patient experiences in England might fit with the literature to date. In this article we present the different types of pressure that we identified from patients' accounts, and a set of criteria derived for the purpose of distinguishing between these different types of pressure.

Method

Twenty-nine qualitative interviews with a purposive subsample from a study of leverage in the English mental health system were analysed.

Results

Participants reported a range of what can be classified as both leveraged and non-leveraged pressures. These were perceived as pressures to adhere to treatment, as well as “staying well.” Leveraged pressures were distinguishable from non-leveraged pressures by the presence of three features: conditionality, a lever and direct communication.

Conclusions

The portrayal of “leverage” in the current literature does not fully capture patient experiences of pressure. Our analysis offers a clearer concept of leverage and other pressures that influence patients, and which may have different legal, ethical and clinical implications.

Full text not available from this repository.

More information

Published date: 2013
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 372259
URI: https://eprints.soton.ac.uk/id/eprint/372259
ISSN: 0160-2527
PURE UUID: 31be5588-663d-4c80-b2e9-9556cee57db1
ORCID for J. Sinclair: ORCID iD orcid.org/0000-0002-1905-2025

Catalogue record

Date deposited: 04 Dec 2014 16:03
Last modified: 15 Jul 2019 21:37

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Contributors

Author: K. Canvin
Author: J. Rugkåsa
Author: J. Sinclair ORCID iD
Author: T. Burns

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