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Ceorcion contexts: how compliance is acheived in interaction
Umeå University, Faculty of Social Sciences, Department of Social Work.ORCID iD: 0000-0002-4540-5373
2016 (English)In: Coercion in community mental health care: international perspectives / [ed] Andrew Molodynski, Jorun Rugkåsa, and Tom Burns, Oxford: Oxford University Press, 2016, p. 131-142Chapter in book (Other academic)
Abstract [en]

Until the last 50 years or so, psychiatric patients mostly interacted with clinical staff within closed institutions permeated with a paternalistic culture. The transition from hospital-based to community care marked a radical shift in treatment ideologies and the general approach to service users with mental illness. In the community we expect services to have values of participation and respect for autonomy. Staff whom patients meet in the community often have different knowledge and value systems from those primarily trained to function within institutions. Community staff may find the idea of coercing service users into complying with a treatment regime quite troubling. Accordingly, when community treatment orders (CTOs) were to be introduced in Sweden in 2008, representatives of municipal social services expressed concern that their staff would have to start using coercion. Relatively little is known about the everyday enactment of coercion in community settings. Emerging research suggests that problematic features observed in inpatient settings occur here as well: patients are not always aware of their formal status and may be subject to various kinds of informal coercion (Lambert et al. 2009; Newton-Howes and Mullen 2011; Sjöström 2012; Canvin et al. 2013). A particularly salient phenomenon is how different kinds of ‘leverages’ (Monahan et al. 2005) or ‘influencing behaviors’ (Rugkåsa et al. 2014) are brought into play to make patients under a CTO comply with things they would not otherwise have chosen (Szmukler and Appelbaum 2008). This chapter will draw upon my experience gained from a number of studies regarding coercion within Swedish mental health care over the past 20 years, both in hospital and community settings (Sjöström 1997, 2000, 2012; Zetterberg et al. 2014). The Swedish arrangements for community compulsion are similar to those in the USA, Australia, New Zealand, England and Wales, as well as other European countries such as Norway and Finland. For the purpose of discussing the practice of coercion in community settings, they are thus likely to be transferable. This chapter proposes a theoretical understanding of the micro-level interaction by which community coercion is enacted. A crucial element in analysing human interaction is the context in which it takes place. I will argue that it is meaningful to think about how staff exercise coercion in terms of how they invoke a certain kind of coercion context when interacting with people under compulsion in the community.

Place, publisher, year, edition, pages
Oxford: Oxford University Press, 2016. p. 131-142
Keywords [en]
coercion, compulsory treatment orders, compliance
National Category
Sociology
Research subject
Sociology
Identifiers
URN: urn:nbn:se:umu:diva-127187DOI: 10.1093/med/9780198788065.003.0008ISBN: 9780198788065 (print)OAI: oai:DiVA.org:umu-127187DiVA, id: diva2:1044075
Funder
Forte, Swedish Research Council for Health, Working Life and WelfareAvailable from: 2016-11-01 Created: 2016-11-01 Last updated: 2018-06-09Bibliographically approved

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Sjöström, Stefan

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