Social factors, care and community treatment orders: complex journeys

This presentation reports findings from a study which explores the social care and environmental factors associated with Community Treatment Orders (CTOs), their discharge and renewal. CTOs allow service users to be treated in the community, rather than in hospital and were designed to prevent relapse and promote stable mental health. A CTO specifies conditions to which the service user must adhere and gives the Responsible Clinician (usually a psychiatrist) the power to recall the service user to hospital. 181 mental health practitioners responded to a survey and 16 service users were interviewed, as were 41 practitioners. Recruitment of service users was challenging and potential reasons for this are explored. Peer researchers were involved throughout the study. Service users and practitioners considered CTOs to be concerned primarily with compliance with medication and the development of insight. Service users generally felt negatively about medication, but they also talked of developing maturity in relation to their difficulties and that medication helped. Compliance provided evidence for discharge, but good relationships and involvement in social activities were also significant in decision making. Service users reported a range of activities, with few talking of loneliness. Views about CTOs were pragmatic and tended to the positive. Good relationships between service users and care co-ordinators were reported by both groups and emerged as one of the strongest themes.