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
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.
References
Mental Health Alliance (2005) Towards a better Mental Health Act. The Mental Health Alliance, London
Department of Health (2008) Code of practice: Mental Health Act 1983. Stationery Office, London
Health and Social Care Act (2012) s.299
Care Quality Commission (2011) Monitoring the Mental Health Act in 2010/11. The Care Quality Commission’s annual report on the exercise of its function in keeping under review the operation the Mental Health Act 1983. Care Quality Commission, London
Dawson J (2005) Community treatment orders: international comparisons. Otago University, Dunedin
Churchill R, Owen G, Singh S, Hotopf M (2007) International experiences of using community treatment orders. Institute of Psychiatry, London
Rugkåsa J, Dawson J, Burns T (2014) CTOs: What is the state of the evidence? Soc Psychiatry Psychiatr Epidemiol. doi:10.1007/s00127-014-0839-7
Burns T, Rugkåsa J, Molodynksi A, Dawson J, Yeeles K, Vazquez-Montes M, Voysey M, Sinclair J, Priebe S (2013) Community Treatment Orders for patients with psychosis: a randomised controlled trial (OCTET). Lancet 381:1627–1633
Steadman HJ, Gounis K, Dennis D, Hopper K, Roche B, Swartz M et al (2001) Assessing the New York City involuntary outpatient commitment pilot program. Psychiatr Serv 52:330–336
Swartz MS, Swanson JW, Wagner HR, Burns BJ, Hiday VA, Borum R (1999) Can involuntary outpatient commitment reduce hospital recidivism?: findings from a randomized trial with severely mentally ill individuals. Am J Psychiatry 156:1968–1975
Gibbs A (2010) Coping with compulsion: women’s views of being on a community treatment order. Aust Soc Work 63:223–233
Gibbs A, Dawson J, Ansley C, Mullen A (2005) How patients in New Zealand view community treatment orders. J Mental Health 14:357–368
Gibbs A, Dawson J, Forsyth H, Mullen R, Tanga TOT (2004) Maori experience of community treatment in Otago, New Zealand. Aust NZ J Psychiatry 38:830–835
Gibbs A, Dawson J, Mullen R (2006) Community treatment orders for people with serious mental illness: a New Zealand study. Br J Soc Work 36:1085–1100
Mullen R, Gibbs A, Dawson J (2006) Family perspectives on community treatment orders: a New Zealand Study. Int J Soc Psychiatry 52:469–478
O’Reilly RL, Keegan DL, Corrig D, Shrikhande S, Natarajan D (2006) A qualitative analysis of the use of community treatment orders in Saskatchewan. Int J Law Psychiatry 29:516–524
Scheid-Cook T (1993) Controllers and controlled: an analysis of participant constructions of outpatient commitment. Sociol Health Illn 15:179–198
Schwartz K, O’Brien A, Morel V, Armstrong M, Fleming C, Moore P (2010) Community treatment orders: the service user speaks exploring the lived experience of community treatment orders. Int J Psychosoc Rehabil 15:39–50
Dawson J, Mullen R (2008) Insight and use of community treatment orders. J Mental Health 17:269–280
Mullen R, Dawson J, Gibbs A (2006) Dilemmas for clinicians in use of community treatment orders. Int J Law Psychiatry 29:535–550
Patton MQ (1990) Qualitative evaluation and research methods. Sage Publications, Newbury Park
Cutcliffe JR (2005) Adapt or adopt: developing and transgressing the methodological boundaries of grounded theory. J AdvNurs 51:421–428
Charmaz K (2006) Constructing grounded theory: a practical guide through qualitative analysis. Sage, UK
Glaser BG (1965) The constant comparative method of qualitative analysis. Soc Probl 12:436–445
Smart C (2007) Personal life. New directions in sociological thinking. Polity Press, London
Department of Health (1999) Report of the expert committee: review of the Mental Health Act 1983. Department of Health, London
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.
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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