Risk versus recovery: Care planning with individuals on community treatment orders

Abstract

Community treatment orders (CTOs) require individuals with a mental illness to accept treatment from mental health services. CTO legislation in South Australia states that treatment and care should be recovery‐focused, although justification for use is predominantly risk‐based, and care often coercive. Although CTOs are contested, individuals, families, and clinicians frequently engage in care planning within this context. This paper examines how the concepts of risk and risk management impact care planning from the perspectives of individuals on CTOs, their families, and clinicians. Ethnographic methods of observation and interview provided a detailed account of the perspectives of each group over an 18‐month period from two community mental health teams in South Australia. Findings show that care planning occurred within a culture of practice dominated by risk. Risk, however, was understood differently by each participant group, with the dominant narrative informed by biogenetic understandings of mental illness. This dominance impacted on the positioning of participant groups in care planning, focus of care contacts, and care options available. To improve care experiences and outcomes for individuals on CTOs, narrow conceptualizations of risk and recovery need to broaden to include an understanding of personal and social adversities individuals face. A broader understanding should reposition participants in the care planning context and rebalance care discussions, from a focus on clinical recovery to recovering citizenship.

A realist evaluation of weighted modalities as an alternative to pro re nata medication for mental health inpatients

“…Additionally, clinicians’ low expectations of consumers’ ability to engage in shared decision‐making act as a further barrier (Dawson et al . 2021; Haugom et al . 2020), and could result in missed opportunities for engaging with consumers who could potentially benefit from psychosocial interventions.…”

“…Shared decision-making in mental health settings remains limited, and focused on discussions about medications, with psychosocial approaches frequently presented as complimentary to medication rather than an alternative (Haugom et al 2020). Additionally, clinicians' low expectations of consumers' ability to engage in shared decision-making act as a further barrier (Dawson et al 2021;Haugom et al 2020), and could result in missed opportunities for engaging with consumers who could potentially benefit from psychosocial interventions. As highlighted by this study, consumers who were highly symptomatic were able to both use and benefit from WMs.…”

Are mental health nurses meeting the requirements of second health professionals in presenting opinions to the court?

“…Risk was clearly identified in 64% ( n = 100) cases and partially in 9% ( n = 14) of the 156 cases analysed. Frequently within mental health services, decision‐making is centred around the risk profile or containment of risk of an individual rather than broader consideration for the context and mitigating factors that exist (Dawson et al, 2021; Manuel & Crowe, 2014).…”

“…Risk, coercive practice and ethical dilemmasRisk was clearly identified in 64% (n = 100) cases and partially in 9% (n = 14) of the 156 cases analysed. Frequently within mental health services, decision-making is centred around the risk profile or containment of risk of an individual rather than broader consideration for the context and mitigating factors that exist(Dawson et al, 2021;Manuel & Crowe, 2014).The current repeal and replacement of the New Zealand MHA present an opportunity to re-frame the emphasis on risk and coercive practice and to consider alternative approaches such as capacity-based criteria, advance directives and supported decisionmaking. The existing framework of the MHA and the SHP template which follows the criteria of the MHA provide little scope for the nursing perspective to step outside the definition of "mental disorder."…”

Supporting self‐determination in mental health recovery: Strategies employed by occupational therapists

“…While all people possess human rights, for many these rights are not actualised. The right to self‐determination for many people living with mental illness has been thwarted or limited by a controlling, coercive and risk‐adverse mental health system (Dawson et al, 2021). Recovery‐oriented and human‐rights driven practice are consistent with a shift from controlling practices to those that support and promote self‐determination (Watson et al, 2014).…”