Community treatment orders and social factors: complex journeys in the mental health system

Haynes, Philip; Stroud, Julia

doi:10.1080/09649069.2019.1663017

Cited by 6 publications

(5 citation statements)

References 45 publications

(41 reference statements)

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“…Much of this is because of the overall context of a Mental Health system in England and Wales that lacks the general resources to creatively meet diverse needs, including social needs. This explains the over reliance on coercive treatment in the community (Haynes & Stroud, 2019)…”

Section: Discussionmentioning

confidence: 99%

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Practitioner Perspectives About Managing Community Treatment Orders (CTOs) in England and the Importance of Social Influences

Haynes

Stroud

2022

Community Ment Health J

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Previous research in England has suggested a medical acceptance of Community Treatment Order (CTO) coercion, but none have explored the importance of social influences on practitioner decision making. A sample of 181 practitioners with Mental Health Act responsibilities completed an online survey. They recorded their perspectives about the influence of medical and social items. Sixteen questionnaire items were subdivided into three operational aspects: discharge, renewal, and recall. Medical item averages scored significantly higher as influences than social items, (medical items mean = 4.43; social items mean = 3.58; t= -19.38, p=0.001). The influence of separate medical and social factors was evidenced by exploratory factor analysis when related to discharge and renewal, but not for recall, where items divided into factors that resembled 'risk' and 'disengagement'. Participants' scores showed no statistically significant difference for a practitioner's professional allegiance. The findings demonstrate that social influences are a homogeneous influence on managing CTOs, in addition to the higher scoring influence of medical factors.

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Section: Discussionmentioning

confidence: 99%

“…This questioning of outcomes is in the context of research that argues practitioners feel under pressure to use CTOs to minimize risk, especially if generic and diverse community mental health services are not readily available (De Ridder, et al, 2016;Haynes & Stroud, 2019).…”

Section: Introductionmentioning

confidence: 99%

Practitioner Perspectives About Managing Community Treatment Orders (CTOs) in England and the Importance of Social Influences

Haynes

Stroud

2022

Community Ment Health J

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“…Some research has highlighted higher rates of CTO use among patients from Black, Asian, and minority ethnic (BAME) backgrounds 7,8 . These disparities may be due to a combination of factors, including bias and discrimination within the mental health system, cultural differences in understandings of mental health and treatment, and a lack of culturally appropriate services and support 9 ris.…”

Section: Introductionmentioning

confidence: 99%

The effects of community treatment orders (CTOs) on readmission to hospital using electronic health records

Yang,

Thygesen,

Werbeloff

et al. 2023

Preprint

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BackgroundCommunity treatment orders (CTOs) are used to manage community-based care for individuals with severe mental health conditions who have been discharged from inpatient care. Evidence examining whether CTOs are successful at reducing rehospitalisation has been mixed.MethodsUsing deidentified electronic health records from 2009-21, we compared patients who had ever been placed on a CTO (n=836) and two other groups of patients who had never been placed on CTO: patients admitted under Section 3 of the Mental Health Act (n=1,182) and outpatients with severe mental health issues (n=7,651). We examined the association between CTOs and rehospitalisation using within-individual stratified multivariable Cox regression.ResultsPatients on CTO were more likely to be male, single, of Black or Mixed ethnicity, and have a severe mental illness diagnosis than patients in the comparison groups. Time spent on CTO was associated with a lower risk of hospitalisation compared to time spent off CTO for the same individual (HR 0.60; 95% CI 0.56-0.64). This decreased risk of hospitalisation remained when we restricted analysis to individuals with a single CTO episode (HR 0.05; 95% CI 0.02-0.11) and when we restricted follow-up time to a patient’s first CTO episode (HR 0.20; 95% CI 0.17-0.25). However, there was no difference in re-hospitalisations when we observed patients starting from the first CTO (HR 1.07; 95% CI 1.00-1.16).ConclusionsWe found that patients on CTO were at lower risk of hospitalisation, though this pattern was not observed when we excluded time prior to the first CTO. Further research should consider whether CTOs provide genuine clinical benefit.

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“…Care planning should be collaborative, personalized and recovery‐focused, 6 however, shared decision‐making (SDM); which promotes autonomy and collaboration, continues to have limited uptake in mental health services 25 . Decision‐making regarding CTO use is based on clinician perceptions of consumers' level of risk, insight and perceived lack of capacity and engagement with services, specifically, medication compliance 26–28 . While CTOs are considered a treatment tool for enhancing consumer stability and safety, they are also used to reduce risk and prevent harm 29,30 .…”

Section: Introductionmentioning

confidence: 99%

“… 25 Decision‐making regarding CTO use is based on clinician perceptions of consumers' level of risk, insight and perceived lack of capacity and engagement with services, specifically, medication compliance. 26 , 27 , 28 While CTOs are considered a treatment tool for enhancing consumer stability and safety, they are also used to reduce risk and prevent harm. 29 , 30 Although recent studies have explored decision‐making regarding reasons for CTO use, explorations of ongoing involvement in decision‐making during all care contacts whilst the person is subject to a CTO have been neglected.…”

Section: Introductionmentioning

confidence: 99%

Community treatment orders and care planning: How is engagement and decision‐making enacted?

Dawson

Muir‐Cochrane

Simpson

et al. 2021

Health Expectations

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Background In many jurisdictions worldwide, individuals with a mental illness may be forced to receive care and treatment in the community. In Australia, legislation states that such care should be driven by a care plan that is recovery‐focussed. Key components in the care planning process include engagement and decision‐making about a person's support needs and care options, with trust being an essential component of care planning relationships. Objective This study examines how these components were enacted during service care contacts for individuals on community treatment orders. Methods The study was located at two community mental health teams in South Australia. Ethnographic observations of care planning discussions between consumers, their carers and clinicians, and interviews with individuals from these groups, were conducted over 18 months. Carspecken's critical ethnography provided a rigorous means for examining the data to identify underlying cultural themes that were informing day‐to‐day care interactions. Results Care planning was not occurring as it was intended, with service culture and structures impeding the development of trusting relationships. Clinicians striving to work collaboratively with consumers had to navigate a service bias and culture that emphasized a hierarchy of ‘knowing’, with consumers assumed to have less knowledge than clinicians. Conclusions Services and clinicians can challenge prejudicial ethical injustice and counter this through testimonial justice and implementation of tools and approaches that support genuine shared decision‐making. Patient or Public Contribution This study included individuals with lived experience of mental illness, their carers and clinicians as participants and researchers.

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Community treatment orders and social factors: complex journeys in the mental health system

Cited by 6 publications

References 45 publications

Practitioner Perspectives About Managing Community Treatment Orders (CTOs) in England and the Importance of Social Influences

Practitioner Perspectives About Managing Community Treatment Orders (CTOs) in England and the Importance of Social Influences

The effects of community treatment orders (CTOs) on readmission to hospital using electronic health records

Community treatment orders and care planning: How is engagement and decision‐making enacted?

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