Perceived Fairness and Effectiveness of Leveraged Community Treatment Among Public Mental Health Consumers in Five U.S. Cities

Policies to leverage adherence with community-based mental health treatment have become widespread; however, little research exists on the attitudes of persons with psychiatric disorders regarding such leverage. This study examines the appraisals of 1,011 persons with psychiatric disorders regarding the fairness and effectiveness of leverage. A majority of consumers perceives leverage to be both fair and effective; these perceptions are highly correlated. Multivariate models suggest that perceived coercion and insight into illness are associated with both outcomes while number of hospitalizations, years in treatment, and appointment reminders are associated with either outcome. However, consumers with a psychotic diagnosis and high barriers to care view leverage as unfair when controlling for effectiveness. Consumers who experience less coercion and have better insight believe that they benefit from formal and informal sanctions to adhere to treatment. However, perceived barriers to care impact the evaluation of the fairness of leverage.