Community treatment orders and the experiences of ethnic minority individuals diagnosed with serious mental illness in the Canadian mental health system

Abstract

IntroductionThe prevalence of Community Treatment Orders (CTOs) in the Western world has generated considerable discussion regarding best practices in the outpatient treatment of the seriously mentally ill. Although problems encountered by ethnic minority communities in the various health care systems have been studied to some degree, there is an acute dearth of information on the effects of CTOs on minority individuals. This paper presents findings from research on the lived experiences of individuals from ethnic minority backgrounds who have been the subjects of CTOs in Toronto, Canada, and their perceptions of its impact on their lives.MethodsUsing a qualitative phenomenological approach, in-depth semi-structured interviews were conducted with individuals who have experienced CTOs. Purposive sampling was used to recruit participants (n = 24) from ethnic minority background in Toronto, Canada.ResultsParticipants perceived both positive and negative impacts of CTOs. The positives included affirmation of experiences with the mental health system; improved rapport with the case management and clinical team, increased medication compliance and feelings of empowerment. The negative feedback included feelings of being coerced and the stigma associated with it.ConclusionsThe findings of this study suggest that although CTOs are not a panacea for every mental health problem, they can be effective with a specific group who choose to follow through with the expectations of the treatment. The author, however argues that for these individuals to be on a CTO before getting better treatment, brings to the fore a number of issues with the mental health system. This is particularly concerning as it pertains to individuals of ethnic minority background.

Canadian Studies on the Effectiveness of Community Treatment Orders

“…Only 2 qualitative studies including the patient's perspective (Table 1), and transferability of findings of one may be limited given it was focused on the experience of a subgroup, those from a visible minority. 24 Existing data suggest that the views of patients, and those of their families and clinicians, are at odds (Table 1). It is not surprising that families support CTOs because, given current funding levels, they are desperate for anything that promises assistance, however illusory.…”

“…The former included improved rapport with the case management and clinical team, increased medication compliance, and greater feelings of self-efficacy. 24 Negative impacts included feelings of being coerced and the associated stigma. 24 …”

Care planning for consumers on community treatment orders: an integrative literature review

“…Case managers can have a significant impact on consumers, who can experience the support as either positive or negative with the potential to ‘either assist or obstruct recovery’ [45, 55]. Owens and Brophy [40] for example, found workers were not making sufficient efforts to manage the risk of recall to hospital or the distress experienced by consumers subsequent to this.…”

“…Consumers reporting positive relationships with workers also appeared to have an overall positive experience of being on a CTO, and associated positive outcomes including improved mental health, support, relationships and occupational gains [27, 43, 55]. Relational aspects mentioned by consumers who reported positive rapport included workers who expressed concern, were helpful, supportive, didn’t view them as patients and with whom they met regularly [23, 35].…”

“…Banks et al [48] suggest the issue of choice is further complicated by the fact that consumers often retrospectively viewed restrictions in choice positively. Whilst studies reported increased acceptance of CTOs by consumers over time, often related to positive gains [6, 36, 55], even those considered to be ‘generally favourable about the CTO’ still identified negative aspects including feeling restricted, stigmatised, untrusted by mental health workers and a lack of control [7, 61]. Three quantitative studies explored consumers’ perceptions of coercion.…”