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Impact of decisional capacity on the use of leverage to encourage treatment adherence
Paul S Appelbaum1, Allison Redlich
1Division of Psychiatry, Law and Ethics, New York State Psychiatric Institute, New York, NY 10032, USA. psa21@columbia.edu
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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