Prevalence of Current Clinical Leverage and Association with Perceived Coercion in Outpatient and Community...

Clinical leverages and pressures are often utilized in psychiatric treatment settings. Clinicians know they are controversial but think of them as useful and relatively harmless. Perception of coercion is known to be deleterious to therapeutic relationship and clinical outcomes. We assessed individuals (N = 137) receiving care in outpatient and community psychiatric settings in a Canadian urban center regarding their current experiences of clinical leverage (in finance, housing, access to/custody of children, and family), and perception of coercion. Analyses show clinical leverage are common (34.8% overall), with access to child and family (15.7%), and financial (14.6%) leverages being most common. Generalised linear models indicated that psychiatric symptomology (p < 0.001) and current financial leverage (p = 0.035) were positively associated with perceptions of coercion. The results highlight that clinical leverages are widespread, associated with perception of coercion, and are likely harmful with negative impact on patient care and outcomes. Efforts to mitigate these impacts are needed.