Table 3.

Case vignette 2

The patient is a 40-year-old man with chronic schizophrenia who lives in an independent flat with practically no social contact and a tendency for self-neglect. He hears voices and believes neighbours are spying on him which makes him very distressed. In the past, he showed marked improvement on medication. He has never harmed himself or others. He is willing to see staff of the community mental health team, but not to take medication or leave the flat to participate in activities

Persuasion

The clinician in the community team who has known the patient for a long time is concerned about the situation and keen to try and reduce the patient’s distress. The clinician talks to the patient and explains the importance of taking medication and engaging in social activities emphasizing that further refusal of treatment may lead to continuous or increased distress and impaired quality of life

Interpersonal leverage

The clinician has repeatedly helped to prevent the patient from being evicted from his flat despite the obvious neglect and inconsistent payments of the rent. The clinician now says that it is frustrating to continue providing care and helping the patient unless the patient shows more engagement with treatment

Inducement

The patient is keen on getting a new TV set, but can only afford it if social welfare provides the funding which requires an application that needs to be supported by the community team. The clinician brings this up and promises to help with such an application if the patient shows more engagement with treatment

Threat

The patient has received another letter from the landlord with the intention to evict him from the flat. The clinician declares that the team will only help the patient to avoid eviction again if he takes medication and/or regularly attends a drop in Centre for some structured activity and social contact