Table 6 Threat

Non-coercion

Reality assessment

E24

(IT426, psychiatrist) It is a way to put on her attention the situation because if I tell she cannot see her daughter if she became clinically unbalanced, it could be a threat, but is at the same time a reality assessment, and it’s better to know it in advance in the context of the community service supported by a psychiatrist than to leave the patient directly facing the consequences of his/her clinical circumstance

Factual Information

E25

(NO208, nurse) When you say threat, I feel that this is not what I do. It is more focusing on the facts. However, I know it is not certain that she understands what I say. However, I […] And then I am thinking in such a way that it is not about giving a warning, in my opinion, it is about talking about what is happening when you become unwell

Actual threat or anticipation

E26

(CR418, psychiatrist) And also, the term threat. Different situations can be described with the same term, meaning it can be an actual threat or merely having someone face consequences which are very real. That (referring to case vignette 2) can sound like a threat, but it is a fact that, if a patient makes noise, the police will come

Risk/benefit balance

E27

CH111, psychologist) I do not see this as a threat, what we are doing is to show the patient the consequences of he/she do not take the medication, we do not say to the patient “you did not take the medication. Then I will ask the intervention of the social services or the court. It is like “look, this is happening, can happen this one or that one, or your family can make this decision”

Coercion

Communication style

E28

(FG209, psychiatrist) Threat is used in the day life practice, but it is a mean of expression than an action with the function to threat […] it is a therapeutic strategy to improve your health without your consent

Highest level of coercion

E29

(EN317, nurse) You know, from a medical point of view and the medical model treatment of a patient with mental health issues, I do not see that happening, because it would mean resorting to the highest level of covert coercion which would be a threat if you have to inform them of the side effects

Unethical

E30

(MX313, psychologist) the threatening someone today is not easy, because there are mechanisms of ethical control in the medical practice, and a doctor is at risk to lose their licence if this happens

Untrustworthy

E31

(CA201, nurse): And I think if you put it out there, ‘if you do not take your meds, you are going to get evicted,’ that does not happen because you are of course advocating for them to keep their housing, then the trust starts to fall apart. Because then you’re threatening things that you are not going to follow through on. Because you want what is in the client’s best interest. So, I think then distrust comes into the relationship, and the relationship is starting to unravel or go the other way- (CA201 Facilitator) And is that something that is a concern to you? (CA201) Trust? Absolutely. Trust is a much more powerful and long-lasting tool than a short-term threat