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  • Oral presentation
  • Open Access

Extent and pattern of leverage use in community mental healthcare: an exploratory study from the UK

  • 1 and
  • 1
BMC Psychiatry20077 (Suppl 1) :S69

  • Published:


  • Mental Health
  • Mental Health Service
  • Community Mental Health
  • Psychiatric Care
  • Policy Debate


As psychiatric treatment shifts from the hospital to the community, policy debates have increasingly focused on the use of legal compulsion to mandate treatment in the community. In service provision, however, it is apparent that legal compulsion is just one form of leverage used to engage patients in community treatment. Research from the USA indicates that approximately half of community-based patients have experienced some form of leverage. The aim of this study was to explore the extent to which leverage is used in the UK and to investigate whether leverage is applied differentially to patients receiving treatment from various mental health service teams.


Structured interviews were conducted with patients receiving treatment from community mental health and substance misuse teams in Oxford, UK. The interview schedule was an adapted version of that used by Monahan et al. [1] in the USA and investigated the use of criminal sanction, welfare benefits, housing and child custody as leverage.


Preliminary data characterizing the sample populations and describing the pattern of leverage experienced by community mental health and substance misuse patients will be presented. Associations between leverage, perceived coercion and sociodemographic and clinical characteristics will also be examined.


This small study provides a basis for further investigation of the use of leverage in community mental healthcare in the UK. An understanding of when and how leverage is used to engage patients in psychiatric care is of importance for both mental health policy and practice.

Authors’ Affiliations

Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX, UK


  1. Monahan J, Redlich AD, Swanson J, Robbins PC, Appelbaum PS, Petrila J, Steadman HJ, Swartz M, Angell B, McNiel DE: Use of leverage to improve adherence to psychiatric treatment in the community. Psychiatr Serv. 2005, 56: 37-44. 10.1176/ ArticlePubMedGoogle Scholar


© Sheehan and Burns; licensee BioMed Central Ltd. 2007

This article is published under license to BioMed Central Ltd.