BJSW Advance Access originally published online on March 21, 2007
British Journal of Social Work 2007 37(3):537-555; doi:10.1093/bjsw/bcm017
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An Examination of the Use of Coercion by Assertive Outreach and Community Mental Health Teams in Northern Ireland
Gavin Davidson is a Ph.D. student at the School of Sociology, Social Policy and Social Work, Queens University Belfast. He is seconded from an assertive outreach team leader post in Homefirst Community Trust, Northern Ireland.
Dr Jim Campbell is a Senior Lecturer at the School of Sociology, Social Policy and Social Work, Queen’s University Belfast, Northern Ireland.
Correspondence to Dr Jim Campbell, School of Sociology, Social Policy and Social Work, Queen’s University Belfast, Belfast BT7 1NN, UK. E-mail: jim.campbell{at}qub.ac.uk
In mental health services over recent decades, the positive move away from hospital-based care to community-based services has entailed that people with higher levels of need are being supported by community mental health services. This paper begins by reviewing the literature on coercion in the field of community-based mental health care and treatment. It is argued that the lack of a critical understanding of the concept and how it is used by practitioners and agencies can have serious repercussions for the rights of service users. Using a quasi-experimental, longitudinal design, the authors then seek to test some of the ideas about coercion by comparing the activities of assertive outreach and community mental health teams in Northern Ireland, particularly the key ideas of perceived coercion, workers’ strategies and engagement with services. Key findings were that assertive outreach appeared to be more successful at reducing perceived coercion, minimizing the need for coercive strategies, engaging high-risk clients and reducing inpatient bed use. These findings are compared with other studies in this area. The authors also argue that there is a need for greater transparency in the way that practitioners use coercive measures and more explicit guidance is required in this crucial area of mental health practice.
Keywords: mental health, coercion, engagement, assertive outreach
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