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


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.


  1. 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/

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Correspondence to Kathleen Sheehan.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Sheehan, K., Burns, T. Extent and pattern of leverage use in community mental healthcare: an exploratory study from the UK. BMC Psychiatry 7, S69 (2007).

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