Informal coercion
In the context of a doctor–patient relationship, Informal coercion is a social process where a healthcare profession tries to make a patient adhere to the healthcare systems desired treatment without making use of formal coercion such as involuntary commitment combined with involuntary treatment. An example of involuntary treatment in mental health care is intramuscular injection with the antipsychotic haloperidol. Informal coercion is often applied by health professionals as part of mental health treatment but is also used by friends and family of a service user. Classification. Several hierarchies of informal coercion have been created. Smuzkler and Appelbaum  defined a five-level hierarchy of coercion: Lidz et al. define nine forms of informal coercion: Interpersonal leverage. If the service user has an emotional dependency on the service provider then the clinician can use displays of disappointment to influence the service user. Inducements. The patient may be demanded to do what a clinician wants to secure access to goods of monetary value such as housing, money, children, and criminal justice. Conditional access to housing is the most common form of inducement in informal coercian, being report by 15-40% of service users. A study of informal coercion in housing  provision found that 60% of noncompliant service users were excluded from the program. Healthcare worker may use inducements such as cigarettes, drinks, or a walk to persuade patients to take medication. Threats. The threat of involuntary commitment or involuntary treatment of treatment may be used to convince patients to comply without using formal coercion. Prevalence. Studies show that most mental heatlh professionals use informal coercion daily in routine practice. Practictioners use informal coercion more than they are aware, and a study showed it is underestimated. 29-59% of service users report informal coercion, according to studies spanning different regions. Judicial  leverage, where a service user complies to treatment to avoid legal proceedings, was reported by 11-23% of service users. Attitudes. 55-69% of service users said they perceived interpersonal leverage as fair and 48-60% as effective. Studies show that patients with higher insight were more favourable to coercion. Patients diagnosed with schizophrenia are more likely to say that informal coercion is taking place, and are more negative about coercion. Service providers, such as mental health nurses or psychiatrists, consider informal coercion as a means to promote compliance, which they felt could prevent worsening of symptoms and the need  for formal coercion. Professionals felt that informal coercion could encourage individuals to take more agency over their lives.