Stigma and Coercion in the Context of Outpatient Treatment for People with Mental Illnesses

The role of stigma in assisted outpatient treatment (AOT), or outpatient commitment, for individuals with mental illness, is often viewed using one of two perspectives: the coercion to beneficial treatment or the coercion to detrimental stigma. The former perspective contends that coercion ultimately reduces stigma, while the latter perspective maintains that coercion increases stigma.

This article describes an investigation into the association between coercion and stigma as it relates to outpatient commitment. It compared 76 AOT individuals to 108 people at the same treatment facility. Participants were interviewed again after 12 months. Data analysis included fixed-effect regression and generalized estimating equations.

Key Findings:                       

  • A negative association existed between psychotic symptoms and social functioning. Over time AOT individuals saw increases in social functioning. These findings support the coercion to beneficial treatment perspective.
  • A positive relationship was found between perceived coercion and devaluation-discrimination. Negative relationships existed between coercion and both quality of life and social functioning. These findings support the coercion to stigma perspective.
  • The more participants perceived devaluation-discrimination at baseline assessment, the lower their self-esteem at the 12-month follow-up.

Support for both the coercion to beneficial treatment and the coercion to detrimental stigma was found in the current investigation. Given evidence that coercion can lead to feelings of stigma, future treatment approaches should attempt to minimize perceptions of coercion.