Pressure and perceived coerciveness in an assertive community treatment program: an exploratory study

Background

Limited evidence suggests that Assertive Community Treatment (ACT) teams may in some cases be unnecessarily coercive. The study aimed to adapt or develop measures of client-perceived coerciveness, and of actual pressure or coercion, in an ACT setting. It also aimed to examine the association between these two constructs, as well as their associations with client sociodemographic and clinical characteristics.

Methods

Uses of pressure or coercion in a high-fidelity ACT team in Montreal, Canada were observed over an eight-week period. Based on these observations, the MacArthur Admission Experience Interview and Survey were adapted to the ACT setting to measure coercion perceived by clients. A new measure of pressure actually applied to clients, based on client self-reports, was also developed. Both measures were administered to a sample of 38 consenting clients. Sociodemographic and clinical measures, symptoms and level of functioning were also measured and correlated with the coercion measures.

Results

Most clients report having been subject to relatively low levels of pressure by ACT team members, and perceived coerciveness also appears low. The two constructs, however, are not correlated. Clients who function at a lower level and those who are more symptomatic report being subject to more pressure; among these, only the former also perceive the team as more coercive.

Conclusion

Actual and perceived coerciveness appear to represent two different constructs. Their levels in a mature, high-fidelity ACT program were low but not negligible. Separate monitoring of pressure applied to clients, and of perceived coerciveness, may be needed.