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APHA Scientific Session and Event Listing

John F. Crilly, PhD, MPH, MSW¹, Virginia Aldige-Hiday, PhD², and Glenn Currier, MD, MPH¹. (1) Psychiatry, University of Rochester, 300 Crittenden Boulevard, Box PSYCH, Rochester, NY 14642, 585-275-0611, john_crilly@urmc.rochester.edu, (2) Sociology and Anthropology, North Carolina State University, Dept. of Sociology, Raleigh, NC 27695

Some important psychiatric treatment interventions are labeled as “coercive,” yet are effective and appropriate when used with high-risk individuals. However, such interventions occur in highly restrictive treatment settings such as state hospitals or jails as well as in the community, blurring the distinction between coercion and treatment. These interventions include involuntary hospitalization, mandatory outpatient treatment, medication over objection, and legal leverage. This symposium examines how certain coercive elements may be categorized as “pre-therapeutic interventions” under certain circumstances with certain populations.High-risk, treatment-recalcitrant clients with mental disorders tend to be pushed by community systems toward emergency/acute settings, long-term state hospital settings, mandated outpatient treatment programs, and the criminal justice system. These treatment settings use specific interventions to initiate and maintain engagement in treatment. The symposium will begin by examining the emergency and acute settings which use interventions such as medication-over-objection and involuntary hospitalization. We will follow the continuum of care to the longer term inpatient settings of state hospitals where eliminating institutionally-condoned coercive settings such as secure care units challenge the larger institution to create non-coercive, leverage-based proactive interventions while promoting institutional culture change. In the outpatient setting, court-ordered mandated outpatient treatment is used in a number of states. Depending on the strength of the legislation, mandated treatment can be a very effective and positive intervention. This is both akin to and different from the use of criminal justice system interventions which mandate mental health treatment as part of an offender's conditions of release.

Learning Objectives:

• This overall symposium will provide the attendee with a discussion around different perspectives of coercion, specifically those involving the use of pre-therapeutic techniques for difficult to reach consumers.

Keywords: Mental Health Care, Criminal Justice

Presenting author's disclosure statement:

Any relevant financial relationships? No