Working alliance, interpersonal trust and perceived coercion in mental health review hearings

The hearings were rated as positive or negative by patients and treating psychiatrists using the MacArthur scales for perceived coercion, perceived procedural justice (legal and medical) and for the impact of the hearing. We rated Global assessment of Function (GAF), Positive and Negative Symptom Scale (PANSS), Working Alliance Inventory (WAI) and Interpersonal Trust in Physician (ITP) scales six months before the hearing and repeated the WAI and ITP two weeks before and two weeks after the hearing, for 75 of 83 patients in a forensic medium and high secure hospital.Psychiatrists agreed with patients regarding the rating of hearings. Patients rated civil hearings (MHTs) more negatively than hearings under insanity legislation (MHRBs). Those reviewed by MHTs had lower scores for WAI and ITP. However, post-hearing WAI and ITP scores were not different from baseline and pre-hearing scores. Using the receiver operating characteristic, baseline WAI and ITP scores predicted how patients would rate the hearings, as did baseline GAF and PANSS scores.There was no evidence that positively perceived hearings improved WAI or ITP, but some evidence showed that negatively perceived hearings worsened them. Concentrating on functional recovery and symptom remission remains the best strategy for improved therapeutic relationships.It has been hypothesised that many aspects of legal process can be regarded as therapeutic jurisprudence, the study of the law as a therapeutic agent, in particular the law's impact on emotional life and on psychological well-being [1]. If the law can be used as a therapeutic agent, then therapeutic relationships and outcomes should be considered in this context. There is evidence that a fair and transparent legal process may have beneficial effects on clinical outcomes, and there is evidence to support this in relation to mental health hearings at the point of committal [2,3]. When post-committal hearings are allowed to become adversarial rather than inqui