Consumers' Perceptions of the Fairness and Effectiveness of Mandated Community Treatment and Related Pressures

OBJECTIVE: Little research has been conducted on the attitudes of persons with psychiatric disorders toward the potentially adverse or beneficial effects of involuntary outpatient commitment and other forms of mandated community treatment. This study examined mental health consumers' appraisals of the fairness and effectiveness of mandated community treatment and related pressures to promote treatment adherence. METHODS: A total of 104 consumers who had been in treatment for schizophrenia or related disorders were interviewed in person to assess their perceptions of mandated community treatment and other legal pressures. RESULTS: Approximately 62 percent of the consumers regarded mandates as effective, and 55 percent regarded them as fair. Perceptions of the effectiveness and fairness of mandates were highly correlated. Consumers who regarded schizophrenia as a biopsychosocial disorder and who viewed themselves as ill and in need of treatment also tended to endorse the fairness and effectiveness of mandates. Those who rejected mandates as ineffective and unfair were more symptomatic and rejected a view of themselves as being ill. CONCLUSIONS: Consumers with schizophrenia who adopt a biopsychosocial view of their own illness, who are less symptomatic, and who have better insight also tend to believe that they benefit from a range of formal and informal sanctions to adhere to treatment and believe that they are imposed in the consumers' best interests and out of concern for their well-being. In contrast, consumers who reject treatment mandates tend to have more psychotic symptoms yet are less likely to perceive themselves as ill.