Walking a Tightrope: Case Management Services and Outpatient Commitment

Abstract

Effective case managers in community mental health are successful at forging a working alliance with recipients. This article explores one key aspect of case management practice, serving involuntary clients, specifically those on outpatient commitment orders. In 19 intensive interviews, a subset of a larger study, case managers shared their perceptions of the utility of outpatient commitment with a focus on how such orders impacted the professional relationship. We argue that the use of advance psychiatric directives and shared decision-making processes can reduce the need for coercive practice.

What Clinicians Say About the Experience of Working With Individuals on Community Treatment Orders

“…The findings from two published articles were combined because they reported results from the same study (14,15). Twelve articles published in academic journals (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) and two governmentsponsored reviews from Ontario, Canada (27,28), included in this review are listed in Table 1. Together these 14 studies incorporated the views of more than 700 participants from six countries.…”

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

“…Mental health workers’ stated CTO goals and conditions should complement care and treatment goals set out in the care plan [30], though workers also expressed scepticism and concern that CTOs could undermine the process of developing consumer led goals [50]. Given these challenges, Brophy and McDermott [24] recommend mental health professionals’ working with consumers on CTOs have advanced clinical and interpersonal skills.…”

“…To address this, Lawn et al highlight the importance of worker empathy in engaging consumers on CTOs and the need for workers to consider ‘the relationship between what is done and how it is done’ (p. 15) [45]. Interestingly in another study, those workers who viewed CTOs as primarily coercive also reported discomfort in working with consumers on CTOs [50]. …”

“…Workers recognised the importance of developing a therapeutic alliance with consumers, and reported on the stress that resulted from working in conditions that at times involved ‘hostility’ , ‘manipulation’ and ‘deceit’ [6], with one case manager describing their role as sometimes more aligned to correctional services than clinical treatment [50]. 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].…”

“…Brophy et al [24] stressed the need for workers to provide psychological, social and occupational interventions and avoid over-focussing on medication. Other interventions proposed to reduce the coercive impact of CTOs and promote consumer participation included the use of advanced directives, shared decision-making and increased access to independent advocates [25, 50]. …”