Patient, psychiatrist and family carer experiences of community treatment orders: qualitative study
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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.
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.
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.
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.
KeywordsCommunity treatment orders Coercion Compulsory community treatment Involuntary outpatient treatment Community mental health
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
- 1.Mental Health Alliance (2005) Towards a better Mental Health Act. The Mental Health Alliance, LondonGoogle Scholar
- 2.Department of Health (2008) Code of practice: Mental Health Act 1983. Stationery Office, LondonGoogle Scholar
- 3.Health and Social Care Act (2012) s.299Google Scholar
- 4.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, LondonGoogle Scholar
- 5.Dawson J (2005) Community treatment orders: international comparisons. Otago University, DunedinGoogle Scholar
- 6.Churchill R, Owen G, Singh S, Hotopf M (2007) International experiences of using community treatment orders. Institute of Psychiatry, LondonGoogle Scholar
- 18.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 15:39–50Google Scholar
- 21.Patton MQ (1990) Qualitative evaluation and research methods. Sage Publications, Newbury ParkGoogle Scholar
- 22.Cutcliffe JR (2005) Adapt or adopt: developing and transgressing the methodological boundaries of grounded theory. J AdvNurs 51:421–428Google Scholar
- 23.Charmaz K (2006) Constructing grounded theory: a practical guide through qualitative analysis. Sage, UKGoogle Scholar
- 25.Smart C (2007) Personal life. New directions in sociological thinking. Polity Press, LondonGoogle Scholar
- 26.Department of Health (1999) Report of the expert committee: review of the Mental Health Act 1983. Department of Health, LondonGoogle Scholar