Autonomy and the Use of Directive Intervention in the Treatment of Individuals with Serious Mental Illnesses: A Survey of Social Work Practitioners

ABSTRACT

Social workers in mental health settings struggle to support the principle of autonomy while weighing the need to directively intervene when there is a risk of harm or when clients are nonadherent to treatment. However, our understanding of this tension is incomplete. We therefore engaged in a survey of 193 social workers in North Carolina regarding attitudes toward autonomy and directive interventions, and examined correlates of these attitudes. Findings revealed that respondents having a client with a psychiatric advance directive were significantly more supportive of client autonomy. Respondents who were licensed, working in an inpatient setting, or had briefer client contacts were more likely to endorse the need for directive interventions, and those working in the public sector reported more use of warnings to improve adherence. Implications for practice, training, and research are discussed.

KEYWORDS:

• Autonomy
• adherence
• directive intervention
• severe mental illness
• social work
• ethics

This work was supported by the Greenwall Foundation, the John D. and Catherine T. MacArthur Foundation Research Network on Mandated Community Treatment, and the National Institute of Mental Health through an Independent Research Scientist Career Award (K02-MH67864) to Dr. Jeffrey Swanson.

The first author thanks Dr. Shelly Birnie-Lefcovitch for his support and suggestions on this article.