A ‘bittersweet pill to swallow’: learning from mental health service users’ responses to compulsory community care in England

Abstract

Two forms of compulsory mental healthcare and supervision in the community are provided within the Mental Health Act 1983: Supervised Discharge Orders (SDOs) and guardianship. At a time when the Government are proposing to extend powers of supervision over people with severe mental illness in the community, it is appropriate that service users' experiences of existing legislation are examined and reported. Despite a range of literature that presents mental health service users' views and experiences, it remains unclear how service users respond to compulsory community mental healthcare in England. The present paper presents the findings of a qualitative investigation into service users' perceptions and experiences of living with SDOs. In the interviews, service users communicated their understanding of why mental health professionals placed them on the order and how their lives have been affected. Individual service users are capable of seemingly contradictory responses, simultaneously accepting and resisting the orders. This paper presents a typology of the range of responses. These responses are fatalism and resignation, dependency, ownership, bargaining, cooperation, resistance, and rejection. The study provides a model with which we can begin to understand how service users respond to compulsory community care where their options are legally constrained.

“Life on Hold”: A Qualitative Study of Patient Experiences with Outpatient Commitment in Two Norwegian Counties

“…The participants wanted help, but did not feel that medication solved their problems. This finding is similar to those of Canvin, Bartlett, and Pinfold (2002) and Gault (2009) who found that clinicians were more focused on social control than on a holistic approach for treatment. Patients missed a sympathetic response when clinicians emphasized symptom treatment and social adjustment more than finding out how the patients were really getting on (Eisenberg, 1977).…”

Acceptability of compulsory powers in the community: the ethical considerations of mental health service users on Supervised Discharge and Guardianship

“…We have described elsewhere the way in which service users adapt their response to compulsory orders in order to maximise their benefits from the ''system'' and how this may coexist with a ''dependency'' on mental health services and intervention. 8 Compulsory supervision in the community relies heavily on the consent and cooperation of the service user and their perception of their own needs. These participants (subject to Supervised Discharge and Guardianship) have consented to a degree of compulsion, and their views may reflect this, 20 especially their expressions of ''belief in the system''.…”

“…These data are discussed elsewhere. 8 The data presented here are derived from participants' responses to seven hypothetical questions (see box) posed in the second part of the interview: hypothetical situations that might occur under Supervised Discharge, Guardianship, or proposed CTO.…”

“…6 The proposed CTO would have similar powers, but additionally contain the new and controversial power to specify medical treatment and enforce medication adherence for service users in the community. 7 Existing descriptions of service users' views of care (reviewed elsewhere 8 ) describe service users' wishes for individual future care and/or treatment in the context of crisis cards, 9 advance directives, [10][11][12][13] priorities for mental health services, 14 15 evaluations of quality, 16 and perceptions of an ''ideal'' service. 17 However, there is no discussion of service users' views about the principles of compulsory care in the community nor their views of the use of these powers for people other than themselves.…”

Evaluating the use of Supervised Discharge and Guardianship in cases of severe mental illness: a follow-up study

“…Although both are used for individuals who have serious mental disorders, and who pose high levels of need and risk, Guardianship tends to be used to address wider issues of social welfare, whilst Supervised Discharge has a more pronounced focus upon risk management through medical treatment (Hatfield, Shaw, Pinfold, Bindman, Evans, et al, 2001). The Mental Health Act has been reviewed and legislation is proposed that will introduce a new power, a ''mental health order'', that can require medication adherence in the community as part of a care plan (Secretary of State for Health, 1999Health, , 20002002).…”