The introduction of supervised community treatment, delivered through community treatment orders (CTOs) in England and Wales, contrasts with the policy of personalisation, which aims to provide service users autonomy and choice over services. This article draws upon findings from a primarily qualitative study which included 72 semi-structured interviews (conducted between January and December 2012) with practitioners, service users and nearest relatives situated within a particular NHS Trust. The article also refers to a follow-on study in which 30 Approved Mental Health Practitioners were interviewed. The studies aimed to develop a better understanding of how compulsory powers are being used in the community, within a policy context that emphasises personalisation and person-centred care in service delivery. Findings from the interview data (which were analysed thematically) suggest that service users were often inadequately informed about the CTO and their legal rights. Furthermore, they tended to be offered little, or no, opportunity to make choices and have involvement in the making of the CTO and setting of conditions. Retrospectively, however, restrictions were often felt beneficial to recovery, and service users reported greater involvement in decisions at review stage. Areas of good practice are identified through which person-centred care can be better incorporated into the making of CTOs.

Child homicide has been a key influence on childcare policy and practice over the last three decades, with a particular focus on the assessment, management and monitoring of situations where children are at risk and on associated inter-agency working. A psychosocial analysis of the pre-offence experiences of 68 adults (mostly parents or carers) who killed or attempted to kill a child identified complex, intricate and heterogeneous processes in respect of their interpersonal relationships, stress and mental health and the relationship of these factors to the offence. These findings indicate that the current policy and practice focus upon procedures and performance in safeguarding children may not address successfully the complex needs of those adults who may pose a risk to children. It is suggested that appropriate therapeutic services should be more readily available. Key words

The perceptions of service users have an important role in determining the value and potential effectiveness of CTOs. A consideration of these issues should be integral to the process of assessing whether a CTO is appropriate in individual cases.

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Social workers and medical practitioners, particularly those in general practice, provide services for individuals who experience social exclusion. Access to medical, health and social care services has been identified as problematic for refugees and asylum seekers, reflecting their marginalised status within society. It is widely accepted that multi-agency responses and working together are key requirements in improving access to services and promoting social inclusion; however, achieving this across professional and agency boundaries often remains challenging. Joint planning and training have been suggested as being important in improving communication, leading to more flexible and creative services. This paper describes the genesis and implementation of a series of innovative interprofessional workshops for medical and social work students, focussing specifically on marginalised groups. Learning and teaching input was developed by, and came from, service users and qualified medical, health and social work practitioners. The paper focuses particularly on the sessions relating to refugees and asylum seekers. The content and structure of the sessions are discussed and students' responses are reported. The implications for future inter-professional learning and practice in relation to socially excluded groups are highlighted.

This reflective discussion draws on data from a collaborative enquiryinto kinship or family and friends practice. It introduces perspectivesfrom complexity and chaos theory as a way of re-examining thechallenges of kinship practice.The discussion highlights the enduringchallenges for practitioners, not least, managing anxiety and uncer-tainty, sustaining continuity and containment, becoming experiencedand taking account of the complex developmental needs of the chil-dren and their families. The discussion particularly raises questionsabout appropriate settings for practitioners to undertake such ademanding area of child and family social wor

Community Treatment Orders (CTOs) have developed rapidly in England and Wales to become a substantial legal intervention. Mixed methods were used to analyse CTOs as one intervention in a complex mental health system and its relationship with social factors.CTOs are used more than expected, with a high number of revocations and renewals. Less than half of CTOs are discharged on time. Service users experience multiple social disadvantages and isolation. They value the stability of a relationship with a care coordinator, but are ambivalent about medication, and can have negative feelings about coercion. Those experiencing recovery tend to initiate social activities, but have poor engagement in care plans, tribunals and reviews. CTOs reduce compulsory hospitalisation, but give rise to human rights issues in the community. Without major social investment to support those with chronic mental health conditions, CTOs may remain the best compromise to balance the demands and requirements of legal and health policy.

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