“Care or control?”: a qualitative study of staff experiences with outpatient commitment orders

Abstract

PurposeOutpatient commitment orders are being increasingly used in many countries to ensure follow-up care of people with psychotic disorders after discharge from hospital. Several studies have examined outpatient commitment in relation to use of health care services, but there have been fewer studies of health professionals’ experiences with the scheme. The purpose of this study was to examine health professionals’ experiences with patients subject to outpatient commitment.MethodsThis was a focus group study using a descriptive and exploratory approach. The study was based on three focus group interviews with a total of 22 participants. Data were analysed using qualitative content analysis.ResultsThe study showed that health professionals had a positive attitude towards outpatient commitment and considered it necessary for patients with psychosis who lacked insight and did not collaborate on treatment. At the same time their attention to patients’ lack of insight could lead to a paternalistic approach more than measures to enhance patient autonomy. This challenged their therapeutic relationship with the patient.ConclusionHealth professionals found it difficult to combine control with therapeutic care, but gave greater emphasis to patients’ need for treatment and continuity of care than to their autonomy. This dilemma indicates a need to discuss whether increased attention to patients’ autonomy rather than insight into their illness would improve treatment cooperation and reduce the use of coercion.

How clinicians make decisions about CTOs in ACT: a qualitative study

“…A Norwegian study showed that CTO practices vary [ 19 ] and that some RCs only met patients at yearly reviews, knew little about the content of local care services and the impact of CTOs on patients’ everyday lives. Some studies suggest that clinicians’ narrow understanding of ‘lack of insight’ and that a one-sided focus on compliance with medication may impede patients’ recovery process [ 18 , 37 , 38 ]. Our data show that the ACT providers perceived that the multidisciplinary nature of their work allowed for frequent patient contact, coordinated support, relationship building and more flexible treatment options.…”

“…Studies show that patients have mixed views of coercion in general and CTOs in particular, while psychiatrists and patients’ relatives are more positive [ 15 – 17 ]. Stensrud et al [ 18 ] found that RCs in Norwegian services were worried about relapse, and therefore reluctant to make dynamic adjustments, even when patients were stable over time. Another Norwegian study [ 19 ] shows great variance in how RCs consider clinical and functional improvement.…”

“…The duration of CTOs seems to depend on the RCs’ attitudes and opinions [ 13 , 14 , 19 ]. Although most clinicians would probably support a shift towards a more person-centred and collaborative decision-making approach, some studies have shown that many clinicians tend to use a more paternalistic type of argumentation in clinical decision-making situations regarding patients with SMI [ 18 , 20 , 21 ].…”

En studie av synet på etiske utfordringerrelatert til arbeid med bruk av tvang hos ansatte i psykiske helsetjenester

“…I samme periode har det vaert en utvikling i psykiske helsetjenester mot mer lokalt baserte tjenester og redusert bruk av institusjon. Som følge av dette har forekomsten av tvang økt utenfor sykehus, noe som igjen reiser nye etiske utfordringer (Riley, Høyer & Lorem, 2014;Stensrud, Høyer, Granerud & Landheim, 2015;Stensrud Høyer, Beston, Granerud & Landheim, 2016). Spørsmål som gjelder kvalitet på tjenestene og etiske utfordringer relatert til bruk av tvang, er beslektet og sammenvevde i psykiske helsetjenester.…”

Responsibilities with conflicting priorities: a qualitative study of ACT providers’ experiences with community treatment orders

“…Even if patients describe CTOs as less coercive than hospital admissions, many patients dislike having to take medications and experience that they have little influence on treatment decisions [ 16 – 19 ]. Studies show that health professionals value the CTO scheme for providing security and structure after discharge from hospital [ 14 , 15 , 20 – 23 ]. Health professionals often describe CTOs as a useful tool to facilitate stable medication and follow-up because of the patients’ lack of insight [ 23 , 24 ].…”