An Examination of the Use of Coercion by Assertive Outreach and Community Mental Health Teams in Northern Ireland

In mental health services over recent decades, the positivemove away from hospital-based care to community-based serviceshas entailed that people with higher levels of need are beingsupported by community mental health services. This paper beginsby reviewing the literature on coercion in the field of community-basedmental health care and treatment. It is argued that the lackof a critical understanding of the concept and how it is usedby practitioners and agencies can have serious repercussionsfor the rights of service users. Using a quasi-experimental,longitudinal design, the authors then seek to test some of theideas about coercion by comparing the activities of assertiveoutreach and community mental health teams in Northern Ireland,particularly the key ideas of perceived coercion, workers’strategies and engagement with services. Key findings were thatassertive outreach appeared to be more successful at reducingperceived coercion, minimizing the need for coercive strategies,engaging high-risk clients and reducing inpatient bed use. Thesefindings are compared with other studies in this area. The authorsalso argue that there is a need for greater transparency inthe way that practitioners use coercive measures and more explicitguidance is required in this crucial area of mental health practice.