Skip to main content


Engagement, workers' strategies, therapeutic relationships, coercion and outcomes in community mental health services in Northern Ireland

Article metrics

  • 1585 Accesses


To explore possible associations between the level of engagement, the strategies workers use to encourage treatment compliance, the therapeutic relationship, perceived coercion and outcomes in a cohort of 'difficult-to-engage' clients receiving either Community Mental Health Team (CMHT) support or Assertive Community Treatment (ACT) support in Northern Ireland. This study also aimed to inform the current review of mental health services in Northern Ireland which is considering service organization and the possible introduction of community treatment orders.


A quasi-experiment design was used as it was not possible to randomly allocate to the CMHT and ACT groups. 76 people met the inclusion criteria and received support over 18 months. Data was collected at 0, 9 and 18 months. 60/76 consented to involvement at baseline and it was possible to collect data on 55/60 at 18 months. In-patient data was collected for all 76. The main scales used were the Service Engagement Scale, the Therapeutic Limit Setting scale, the Working Alliance Inventory and the Perceived Coercion Scale.


In accordance with most US studies of assertive community treatment but in contrast to recent UK studies, this study found it to be effective at reducing the need for both voluntary and involuntary inpatient hospital use. In considering the therapeutic relationship only 24/55 clients had the same key-worker after 18 months.


Assertive community treatment should be considered as an effective means of engaging clients, building trusting relationships and promoting stability and may obviate the need to introduce more coercive measures such as community treatment orders.

Author information

Correspondence to Gavin Davidson.

Rights and permissions

Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Reprints and Permissions

About this article

Cite this article

Davidson, G. Engagement, workers' strategies, therapeutic relationships, coercion and outcomes in community mental health services in Northern Ireland. BMC Psychiatry 7, S53 (2007) doi:10.1186/1471-244X-7-S1-S53

Download citation


  • Mental Health Service
  • Assertive Community Treatment
  • Therapeutic Relationship
  • Community Mental Health Service
  • Coercive Measure