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Patient, psychiatrist and family carer experiences of community treatment orders: qualitative study

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Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

Current literature on personal experiences of community treatment orders (CTO) is limited. This paper examines participants’ experiences of the mechanisms via which the CTO was designed to work: the conditions that form part of the order and the power of recall. We also report an emergent dimension, legal clout and participants’ impressions of CTO effectiveness. This paper will contribute to a fuller picture of how the law is implemented and how CTOs operate in practice.

Methods

In-depth qualitative interviews were conducted with a purposive sample of 26 patients, 25 psychiatrists and 24 family carers about their experiences and views of CTOs. Data were analysed using the constant comparative method.

Results

All three sample groups perceived the chief purpose of CTOs to be medication enforcement and that its legal clout was central to achieving medication adherence. Understanding of how the inbuilt mechanisms of the CTO work varied considerably: participants expressed uncertainty regarding the enforceability of discretionary conditions and the criteria for recall. We found mixed evidence regarding whether recall simplified responses to relapse or risk. The range of experiences and views identified within each group suggests that there is no single definitive experience or view of CTOs.

Conclusions

The (perceived) focus of the CTO on medication adherence combined with the variations in understanding within and across groups might not only have consequences for how CTOs are viewed and subsequently experienced, but also for broader goals in patient care and patient and carer involvement.

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Notes

  1. A Mental Health Act assessment involves specially trained professionals (usually an AMHP and two doctors) assessing a person to see if they meet two criteria: (1) Suffering from a mental disorder of a nature or degree which warrants detention in a hospital for assessment or treatment, and (2) Ought to be detained in the interests of their health, safety or for the protection of others.

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Acknowledgments

We wish to thank the participants for sharing their experiences. We would also like to thank Anna Sulman, Research Assistant, who conducted some of the patient interviews. This article presents independent research funded by the National Institute of Health Research (Program Grant for Applied Research, grant number RP-PG-0606-1006). The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK

    Krysia Canvin, Jorun Rugkåsa & Tom Burns

  2. Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway

    Jorun Rugkåsa

  3. University Department of Psychiatry, University of Southampton, Southampton, UK

    Julia Sinclair

Authors
  1. Krysia Canvin
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  2. Jorun Rugkåsa
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  3. Julia Sinclair
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  4. Tom Burns
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Correspondence to Krysia Canvin.

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Canvin, K., Rugkåsa, J., Sinclair, J. et al. Patient, psychiatrist and family carer experiences of community treatment orders: qualitative study. Soc Psychiatry Psychiatr Epidemiol 49, 1873–1882 (2014). https://doi.org/10.1007/s00127-014-0906-0

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  • DOI: https://doi.org/10.1007/s00127-014-0906-0

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