P-646 - Using institutional ethnography to explore community treatment orders

Abstract

There is considerable debate concerning the use of Community Treatment Orders (CTOs) in mental health practice. CTOs mandate individuals with mental illness to engage in community treatment (e.g. medication or other therapy) against their will (CMHA, 1998). The purpose of this presentation is to present the preliminary findings of a study using Institutional Ethnography (IE) that is exploring the consideration and implementation of CTOs in Newfoundland and Labrador, Canada. Interestingly, this province has CTO implementation rates that are far less than the Canadian average. Using IE offers the potential to elucidate the everyday work/life experiences occurring within an institution and to show how they are influenced by institutional social structures and discourses known as ruling relations (Smith, 2005). Participants in this study include clients, family members, and health professionals who have experience with the consideration or use of CTOs in mental health settings. Data collected through interviews and review of institutional documents are examined for evidence of the social web of influence that governs everyday actions. These social and ruling relations are mapped in accordance to their relationship to and influence over one another. The results obtained are of considerable interest to practitioners, advocacy groups, families, and individuals with mental health concerns. In bringing these social patterns and structures to light, there is hope that the resulting awareness will foster a greater willingness for individuals involved with CTOs and the mental health system to engage with one another on a more meaningful level.

Conducting Analysis in Institutional Ethnography

“…This was the case for Nicole Snow (2015) who was studying mental health legislation in Newfoundland, Canada. Her specific interest was in how community treatment orders (CTOs) were working.…”

“…For Snow (2015), the process of data collection began with her careful consideration of what she already knew — both in the local and in the extra-local work processes . She then interviewed a relative of a person on a CTO (being unsuccessful in recruiting a person who was actually subjected to CTO), health-care workers, and bureaucrats.…”

“…Next, Snow (2015) began filling in the gaps—identifying what she knew and what she did not know. For example, she learned about how the justice system was activated when a person’s mental illness was judged to be “unstable” and the exact processes of “revoking” a CTO and what that meant.…”