Social factors, care and Community Treatment Orders (CTOs). Service user and practitioner perspectives: A report on preliminary findings from Phase One of the study, January 2017

Service users on a Community Treatment Order (CTO) in England are in a unique position since they can have conditions about their care imposed upon them. Available since 2008 for service users who have been on a Mental Health Act treatment order (s3, s37), CTOs were introduced to compel service users who did not accept treatment, deteriorated and were re admitted to hospital - the so called ‘revolving door' syndrome - to engage with treatment and support. CTOs have been used extensively: 5,426 people were on a CTO in 2015/16 with 2,294 recalls and 3,120 revocations/ discharges (HSCIC 2016). A disproportionate number of those on a CTO are from minority ethnic groups (CQC 2015). Research has focussed on the effectiveness of CTOs (Burns et al 2013) and on service user and practitioner views and experiences (e.g. Coyle et al 2013). There is little research on the factors taken into account in decisions to discharge, renew or revoke CTOs and such evidence focusses on compliance with medication (e.g. DeRidder et al 2016). There has been no focus on service users' social environments and support and how, and whether, these are taken account of in decision making. The analysis of regional data in this study showed that users tended to be men and that women tended to be older. Social challenges and difficulties found included homelessness; being alone; having no occupation. Service users were also older indicating their life had not been going well for a time and that ‘late' intervention would require significant resource. The survey of psychiatrists and care co ordinators found that while compliance with medication and risk were central influences in decision making, social factors, such as social isolation/ relationship issues, accommodation status and occupation were also key considerations. Understanding of service users' social environments is now being refined through qualitative interviews with service users and practitioners and preliminary findings will also be reported.