Compulsion in the community: mental health professionals' views and experiences of CTOs

Coyle, Delphine; Macpherson, Rob; Foy, Chris; Molodynski, Andrew; Biju, Maya; Hayes, Joseph

doi:10.1192/pb.bp.112.038703

Cited by 11 publications

(12 citation statements)

References 15 publications

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“…Different understandings of the patient’s healthcare needs can complicate the therapeutic alliance [ 10 ]. Our results showing that therapists justified OC as a means to support the patient concur with findings in other studies [ 11 , 14 , 27 ]. This also agrees with the fact that three out of four OC decisions in Norway are based on an assessment of the patient’s treatment needs [ 44 ].…”

Section: Discussionsupporting

confidence: 92%

“…The participants felt that the coercive framework of OC challenged their therapeutic relationship, the coercion itself becoming a burden. Other studies have demonstrated the same concerns [ 14 , 27 ]. It was difficult to assess when the benefits outweighed the drawbacks, especially where clinicians assessed the treatment effect of coercion as small.…”

Section: Discussionsupporting

confidence: 61%

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

Stensrud

Høyer

Beston

et al. 2016

Soc Psychiatry Psychiatr Epidemiol

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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.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 61%

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

Stensrud

Høyer

Beston

et al. 2016

Soc Psychiatry Psychiatr Epidemiol

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“…There are some studies internationally on what professionals think of CCT, they find generally positive attitudes towards CCT [9][10][11][12][13]. We could not find any studies that identify mental health care workers' opinions on CTH.…”

Section: Introductionmentioning

confidence: 65%

Compulsory treatment in patients’ homes in the Netherlands: what do mental health professionals think of this?

et al. 2020

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Background: Compulsory treatment in patients' homes (CTH) will be introduced in the new Dutch mental health legislation. The aim of this study is to identify the opinions of mental health workers in the Netherlands on compulsory community treatment (CCT), and particularly on compulsory treatment in the patients' home. Methods: This is a mixed methods study, comprising a semi-structured interview and a survey. Forty mental health workers took part in the semi-structured interview about CCT and 20 of them, working in outpatient services, also completed a questionnaire about CTH. Descriptive analyses were performed of indicated (dis) advantages and problems of CCT and of mean scores on the CTH questionnaire. Results: Overall, the mental health workers seemed to have positive opinions on CCT. With respect to CTH, all mean scores were in the middle of the range, possibly indicating that clinicians were uncertain regarding safety issues and potential practical problems accompanying the use of CTH. Conclusions: The majority of the participating mental health workers in this study had a positive attitude towards CCT, but they seemed relative uncertain about potential possibilities and problems of working with CTH.

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“…Many patients subject to CTOs had a recent history of treatment discontinuation, and as other studies show, CTOs were described as a clinical tool to promote treatment adherence to stabilize the patients’ condition and to prevent hospital re-admission [ 14 , 15 , 20 – 23 ]. The participants emphasized the importance of communication and of facilitating patient cooperation.…”

Section: Discussionmentioning

confidence: 99%

“…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 ].…”

Section: Introductionmentioning

confidence: 99%

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

Stuen

Landheim

Rugkåsa

et al. 2018

BMC Health Serv Res

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BackgroundPatients with severe mental illness may be subjected to Community Treatment Orders (CTOs) in order to secure that the patients adhere to treatment. Few studies have investigated the use of CTOs within an Assertive Community Treatment (ACT) setting, and little is known about how the tension between the patients’ autonomy and the clinicians’ responsibility to act in the patients’ best interest are resolved in practice. The aim of this study was to explore the service providers’ experiences with CTOs within an ACT setting.MethodsThe study was based on reviews of case files of 15 patients, eight individual qualitative in depth interviews and four focus group interviews with service providers involved in ACT and decisions related to CTOs. A modified grounded theory approach was used to analyze the data.ResultsThe main theme ‘responsibility with conflicting priorities’ emerged from data analysis (case file reviews, individual interviews and focus group interviews). The balance between coercive approaches and the emphasis on promoting patient autonomy was seen as problematic. The participants saw few alternatives to CTOs as long-term measures to secure ongoing treatment for some of the patients. However, participants perceived the ACT model’s comprehensive scope as an opportunity to build rapport with patients and thereby better meet their needs. The team approach, the ACT providers’ commitment to establish supportive relationships and the frequent meetings with patients in their home environment were highlighted. The ACT approach gave them insight into patients’ everyday lives and, in some cases a greater sense of security when considering whether to take patients off CTOs.ConclusionsMany of the participants viewed CTOs as helpful in securing long-term treatment for patients. CTO decision-making was described as challenging and complex and presented the providers with many dilemmas. The ACT approach was considered as helpful in that it afforded comprehensive, patient-centered support and opportunities to build rapport.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3097-7) contains supplementary material, which is available to authorized users.

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Compulsion in the community: mental health professionals' views and experiences of CTOs

Cited by 11 publications

References 15 publications

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

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

Compulsory treatment in patients’ homes in the Netherlands: what do mental health professionals think of this?

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

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