Community Care or Therapeutic Stalking: Two Sides of the Same Coin?

Abstract

Although the government of the United Kingdom strives to address the needs of individuals engaged in mental health services, its policies must, by their nature, reflect a utilitarian approach. When a client chooses to disengage from services, mental health professionals can find themselves in an ethical dilemma in which adhering to policies can lead them to hyperactive conduct, whereby the client may experience what feels more like stalking behavior than therapeutic care.

Community treatment orders: the ethical balancing act in community mental health

“…There is a false sense that clients in the community are more free and independent. On the contrary, the high degree of monitoring to which mentally ill clients are subjected to has been referred to in the literature as ‘therapeutic stalking’ (Graham 2006, p. 41). Such surveillance may be due in part to the perceived lack of social control that can be achieved in the community setting (Geller et al.…”

“…Although individuals with acute exacerbations of their mental illness are living in the community (Geller et al. 2006, Graham 2006), the vast majority do not pose a safety threat to the general public. However, this debate circles back to the concept of what is considered dangerous and what is an acceptable or unacceptable amount of risk.…”

“…Alternatives to CTOs include assertive outreach that may involve mental health professionals monitoring individuals' progress and observing or performing interventions such as medication administration. This alternative is not without its concerns as it too is often associated with paternalism and can be experienced as interference (Timms & Borrell 2001, Graham 2006). The CMHA promotes the use of the PACT or Program for Assertive Community Treatment model as an alternative to the use of CTOs.…”

“…As Trueman (2003) notes, ‘In retrospect, the community was not ready to handle the influx of so many former inpatients’ (p. 3). Increasingly, individuals with chronic mental illness are expected to access community care even for acute exacerbations of their symptoms and to remain in the community setting (Graham 2006). With the increased emphasis on community care comes the ethical obligation to better support people with severe persistent mental illness in maintaining their well‐being within their communities.…”

A review of the literature on the historical development of community mental health services in the United Kingdom

“…The obvious social control mechanisms of the institution may have simply been replaced by other forms of surveillance. Graham (2006) and Mason & Mercer (1996) highlight how community mental health practitioners, in services such as Community Forensic teams and Assertive Outreach, have become agents of social control. They suggest that the behaviours exhibited by practitioners to engage service users against their wishes could in other circumstances be construed as stalking (Mason & Mercer 1996, Graham 2006).…”