Community treatment orders: learning from experiences of service users, practitioners and nearest relatives

Abstract

The perceptions of service users have an important role in determining the value and potential effectiveness of CTOs. A consideration of these issues should be integral to the process of assessing whether a CTO is appropriate in individual cases.

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

“…Several studies highlighted the lack of usefulness of CTOs to those clients whereby coercion experienced from being on the CTO cancelled out any gains [35, 36] with clinicians reporting consumers most likely to benefit from a CTO being those with a level of insight into their mental health problems, and therefore more likely to collaborate with services [36, 37]. Consumers needed to accept the validity of a treatment order for CTOs to be a viable treatment option [37, 38] with Mullen et al [39] suggesting that if good therapeutic relationships were not achieved within a reasonable period of time they should be discharged from the CTO to voluntary care.…”

“…For the majority of participants in the included studies the primary purpose of the CTO was medication compliance, which then became the focus of interactions between workers and consumers [36, 45]. Workers and family members often linked the need for medication compliance with poor insight and increased risk of harm (to self or others) [46].…”

“…Some carers reported their involvement in care planning as infrequent, which was seen as contradictory given the high level of care they provided [42]. Others reported having an increased voice subsequent to the CTO process and feeling that their caring role was more recognised [36]. Interestingly, some carers reported increased involvement at the initiation of the CTO with less communication from mental health services over time, which was the opposite to reported consumer experiences of increased involvement with time [48, 54].…”

“…Overall, as consumer participation was reported to be low, increased involvement was recommended at all stages of the CTO process to enhance consumer empowerment [48]. Authors of a recent study found ‘CTOs were more successful when they were a carefully planned intervention [inclusive of the consumer and their family], rather than where they were made almost as a matter of course’ (p.91) [36]. Mfoafo-M’Carthy and Williams [5] went further and suggested mandated treatment could be discussed and presented as an intervention option under an advanced directive with individuals during a period of improved capacity.…”

“…To redress the balance of power, workers have a responsibility to empower consumers by providing clear information about CTO processes and facilitating as much choice and involvement as possible in decision-making at all stages [35, 41, 48]. Workers acknowledged the ‘legal recognition’ of care that came with CTOs placing a greater responsibility on them to effectively engage consumers [36] as well as the challenges of effective engagement and the intensive nature of support required of person-centred care [48]. Brophy and McDermott [24] considered continuity of care important in providing quality care with this client group and suggested psychiatrists take a more central role as they were typically a more stable team member.…”