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

Abstract

Objectives:To explore mental health service users’ views of existing and proposed compulsory powers.Design:A qualitative study employing in-depth interviews. Participants were asked to respond to hypothetical questions regarding the application of compulsory powers under the Mental Health Act 1983 for people other than themselves.Setting:Community setting in Southeast England.Participants:Mental health service users subject to Supervised Discharge/Guardianship.Results:Participants considered that the use of compulsory powers was justified if there were some ultimate benefit, and if there was evidence of mental health problems, dangerousness, or a lack of insight. However, participants rejected intrusions into their autonomy and privacy.Conclusions:This paper’s participants indicated that the proposed CTO may be unacceptable because it would threaten service users’ autonomy. Service users’ acceptance of proposed changes is conditional and they emphasised the importance of consent; there is no suggestion that consent will be required for the CTO. The findings also have implications for the exploration of mental health service users’ views and how they might contribute to policy, service planning, and research.

Patient's experiences of involuntary hospital admission and treatment: A review of qualitative studies

“…However, these findings are in line with findings from other studies examining outcomes of coercive treatment in different settings, such as long-stay psychiatric wards (Pereira et al, 2005), supervised community treatment and guardianship (Canvin et al, 2005), assertive community treatment under assertive outreach teams (Watts & Priebe, 2002) and acute psychiatric hospital admission among both voluntary and involuntary patients (Bennett et al, 1993). Overall, people suffering from mental health problems are particularly sensitive against any intrusions into their autonomy and privacy.…”

Understanding psychiatric institutionalization: a conceptual review

“…For example, institutions can be understood as a web of people, ideas and practical/potential power in our contemporary society [55]. Moreover, patient-nurse relationships are recognized as an essential aspect of therapeutic psychiatric in-patient care [56].…”

Psychiatric patients’ views on why their involuntary hospitalisation was right or wrong: a qualitative study

“…As a response to this perceived threat, patients might reject psychiatric services altogether to avoid feeling stigmatised and devalued [27][28][29][30].…”

“…This is not only an ethical and humane issue, but might also lead to improved treatment outcomes. Evidence indicates that viewing treatment as right and/or satisfactory and perceiving lower levels of coercion is linked to clinical improvement [29][30][31][32], reduced involuntary readmissions [4], increased engagement with services and better therapeutic relationships after discharge [5,33]. Specific interventions to address these patients' concerns do not exist yet.…”