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Impact of Decisional Capacity on the Use of Leverage to Encourage Treatment Adherence

Community Mental Health Journal volume 42, pages 121–130 (2006)Cite this article

Abstract

Leverage is often applied to persons with mental illnesses who live in the community to encourage them to adhere to treatment. Given the underlying assumption that the targets of such leverage are unable to make good decisions about treatment on their own, one might expect that decisional incapacity regarding treatment would correlate with the use of leverage. As part of a multi-site study of leverage in community treatment, 120 subjects at two sites reported on their leverage experiences and completed a decisional capacity assessment with the MacCAT-T. No strong or consistent associations were found between capacity and use of leverage, raising questions about the basis on which decisions to employ leverage are being made.

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Acknowledgments

This work was supported by the Research Network on Mandatory Outpatient Treatment of the John D. and Catherine T. MacArthur Foundation. The authors thank Karen Albert and Eric Elbogen for assistance with data collection, and Pamela Robbins and Laura Morris for help with data analysis.

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Affiliations

  1. Director, Division of Psychiatry, Law and Ethics, New York State Psychiatric Institute, New York, NY, USA

    Paul S. Appelbaum M.D.

  2. Policy Research Associates, Delmar, NY, USA

    Allison Redlich Ph.D.

  3. Director, Division of Psychiatry, Law and Ethics, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA

    Paul S. Appelbaum M.D.

Authors
  1. Paul S. Appelbaum M.D.
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  2. Allison Redlich Ph.D.
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Corresponding author

Correspondence to Paul S. Appelbaum M.D..

Additional information

Paul S. Appelbaum is affiliated with the Division of Psychiatry, Law and Ethics, New York State Psychiatric Institute, New York, NY, USA.

Allison Redlich is affiliated with the Policy Research Associates, Delmar, NY, USA.

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Appelbaum, P.S., Redlich, A. Impact of Decisional Capacity on the Use of Leverage to Encourage Treatment Adherence. Community Ment Health J 42, 121–130 (2006). https://doi.org/10.1007/s10597-005-9015-6

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  • DOI: https://doi.org/10.1007/s10597-005-9015-6

Keywords

  • leverage
  • adherence
  • capacity
  • competence