Persuasion or Coercion? An Empirical Ethics Analysis About the Use of Influence Strategies in Mental Health Community Care

Course overview

Course Description: This course is based on material published in BMC Health Services Research and is available as an open-access article. Influence strategies such as persuasion and interpersonal leverage are used in mental health care to influence patient behavior and improve treatment adherence. One ethical concern about using such strategies is that they may constitute coercive behavior ("informal coercion") and negatively impact patient satisfaction and the quality of care. However, some influence strategies may affect patients' perceptions, so an umbrella definition of "informal coercion" may be unsatisfactory. Furthermore, previous research indicates that professionals also perceive dissonance between theoretical explanations of informal coercion and their behaviors in clinical practice. This study analyzed mental health professionals' (MHPs) views and the perceived ethical implications of influence strategies in community care. Qualitative secondary data analysis of a focus group study was used to explore the conflict between theoretical definitions and MHPs' experiences concerning the coerciveness of influence strategies. Thirty-six focus groups were conducted in the main study, with 227 MHPs from nine countries participating. The findings indicate that not all the influence strategies discussed with participants can be defined as "informal coercion", but they become coercive when they imply the use of a lever, have the format of a conditional offer and when the therapeutic proposal is not a patient's free choice but is driven by professionals. MHPs are rarely aware of these tensions within their everyday practice; consequently, it is possible that coercive practices are inadvertently being used, with no standard regarding their application. Our findings suggest that levers and the type of leverage used in communications with the patient are also relevant to differentiating leveraged and non-leveraged influence. Our findings may help mental health professionals working in community care to identify and discuss influence strategies that may lead to unintended coercive practices. This course on influence strategies in mental health community care is designed for clinical social workers, psychologists, professional counselors, nurses, and substance abuse counselors who do clinical work. This course is appropriate for intermediate and advanced level practitioners who wish to develop their expertise with influence strategies in mental health community care. The course material includes a literature review of research. It may also be useful for licensed clinicians who require continuing clinical education courses for license renewal. The course is based on a journal article that includes research. It contains statistical analysis and data that some clinicians enjoy reading and others do not. A significant benefit of reading peer reviewed research-based articles for continuing education is that they provide practitioners with the latest findings in their field. Authors: Valenti, Giacco Learning Objectives: This course will provide the practitioner with detailed information regarding influence strategies in mental health community care. Specifically, a professional will: Identify the role of influence strategies in mental health care. Recognize different influence strategies Describe the effects of levers on patient outcomes Citation: Valenti, E., & Giacco, D. (2022). Persuasion or coercion? An empirical ethics analysis about the use of influence strategies in mental health community care. BMC health services research, 22(1), 1273. https://doi.org/10.1186/s12913-022-08555-5