An exploration of service user and practitioner experiences of Community Treatment Orders

Introduction

Current adult social care policy emphasises service user choice and personalised services. These principles appear to conflict with Community Treatment Orders (CTO’s), introduced by the Mental Health Act 2007.

CTO’s allow service users to be discharged from detention in hospital and reside and be treated compulsorily in the community, if specific criteria are met. A CTO has two mandatory conditions relating to psychiatric examinations, but discretionary conditions can be specified also.

Service users and professionals opposed the introduction of CTO’s, raising practical, ethical and human rights concerns. A contradiction between increased use of compulsion and a policy focus on increased choice and independence of mental health service users was highlighted, along with questions about the capacity of community based services to support implementation.

To date, use of CTO’s has exceeded estimates, even though research does not demonstrate conclusively whether compulsory community treatment benefits or improves outcomes for service users. Further, there is no published research on service users’ experiences of CTO’s, professionals’ experiences of managing them, or on the role of associated social care provisions. Processes of negotiation and discussion between professionals and users through which agreement is reached about the CTO and the nature of discretionary conditions remain unexplored.

This study sought to inquire into these issues, exploring social care practice in the context of compulsion.