Exploratory study of the use of community treatment orders with clients of an Ontario ACT team

ABSTRACT Community Treatment Orders (CTOs) have raised questions about coercion, lack of autonomy, and effectiveness in reducing hospitalizations and improving service users’ quality of life. This study examined the experiences of clients and clinicians when CTOs are used in combination with Assertive Community Treatment (ACT) in a recovery oriented approach. Eleven clients who were or had previously been on a CTO and eight ACT clinicians were interviewed. Although most clients had negative feelings about CTOs, some acknowledged their lives had improved. Clinicians reported that the decision to employ a CTO is sometimes debated within the team but they agreed that combining CTOs and ACT resulted in regular access to mental health supports, fewer hospitalizations and overall improvement of quality of life for their clients.

[1]  S. Kisely,et al.  Compulsory community and involuntary outpatient treatment for people with severe mental disorders. , 2017, The Cochrane database of systematic reviews.

[2]  G. Fahy,et al.  Supervised community treatment: patient perspectives in two Merseyside mental health teams , 2013 .

[3]  J. Ridley,et al.  Subjective experiences of compulsory treatment from a qualitative study of early implementation of the Mental Health (Care & Treatment) (Scotland) Act 2003. , 2013, Health & social care in the community.

[4]  E. Crowe,et al.  An eleven-year evaluation of the effect of community treatment orders on changes in mental health service use. , 2013, Journal of psychiatric research.

[5]  S. Dye,et al.  Supervised community treatment: 2-year follow-up study in Suffolk , 2012 .

[6]  J. C. Perry,et al.  Assessing the Outcome of Compulsory Treatment Orders on Management of Psychiatric Patients at 2 McGill University- Associated Hospitals , 2012, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[7]  S. Lawton-Smith.  Supervised community treatment , 2011 .

[8]  L. Davidson,et al.  Recovery-oriented service provision and clinical outcomes in assertive community treatment. , 2011, Psychiatric rehabilitation journal.

[9]  Fong Chan,et al.  Consumer Perceptions of Assertive Community Treatment Interventions , 2011, Community Mental Health Journal.

[10]  M. Salyers,et al.  The Work of Recovery on Two Assertive Community Treatment Teams , 2011, Administration and Policy in Mental Health and Mental Health Services Research.

[11]  Richard A. Van Dorn,et al.  Assessing outcomes for consumers in New York's assisted outpatient treatment program. , 2010, Psychiatric services.

[12]  C. WilliamsCharmaine,et al.  Coercion and Community Treatment Orders (CTOs): One Step Forward, Two Steps Back? , 2010 .

[13]  Patricia Moore,et al.  Community Treatment Orders: The Service User Speaks. Exploring the Lived Experience of Community Treatment Orders , 2010 .

[14]  Iris Gault.  Service-user and carer perspectives on compliance and compulsory treatment in community mental health services. , 2009, Health & social care in the community.

[15]  R. Kydd,et al.  Compulsory community mental health treatment: literature review. , 2009, International journal of nursing studies.

[16]  S. Farrell,et al.  Community Treatment Orders: Beyond Hospital Utilization Rates Examining the Association of Community Treatment Orders with Community Engagement and Supportive Housing , 2009, Community Mental Health Journal.

[17]  M. Hotopf,et al.  International experiences of using community treatment orders , 2007 .

[18]  D. Keegan,et al.  A qualitative analysis of the use of community treatment orders in Saskatchewan. , 2006, International journal of law and psychiatry.

[19]  V. Braun,et al.  Using thematic analysis in psychology , 2006 .

[20]  B. Felton,et al.  ACT team members' responses to training in recovery-oriented practices. , 2006, Psychiatric rehabilitation journal.

[21]  J. Dawson,et al.  How patients in New Zealand view community treatment orders , 2005, Journal of mental health.

[22]  S. Farrell,et al.  Community Treatment Orders: Profile of a Canadian Experience , 2005, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[23]  M. G. Barnes,et al.  The client experience of assertive community treatment: a qualitative study. , 2005, Psychiatric rehabilitation journal.

[24]  T. Krupa,et al.  How do people who receive assertive community treatment experience this service? , 2005, Psychiatric rehabilitation journal.

[25]  J. E. Gray,et al.  Canadian compulsory community treatment laws: recent reforms. , 2005, International journal of law and psychiatry.

[26]  L. Brophy,et al.  The Efficacy of Involuntary Treatment in the Community , 2004 .

[27]  KrupaTerry,et al.  Challenges faced by service providers in the delivery of Assertive Community Treatment. , 2004 .

[28]  D. Wasylenki,et al.  Participant perspectives on satisfaction with assertive community treatment. , 2004, Psychiatric rehabilitation journal.

[29]  Shelley Trueman.  Community treatment orders and Nova Scotia--the least restrictive alternative? , 2003, Health law journal.

[30]  S. Priebe,et al.  A Phenomenological Account of Users' Experiences of Assertive Community Treatment , 2002, Bioethics.

[31]  R. Drake,et al.  Moving assertive community treatment into standard practice. , 2001, Psychiatric services.

[32]  J. Borum,et al.  The Effectiveness of Involuntary Outpatient Treatment: Empirical Evidence and the Experience of Eight States , 2001 .

[33]  R. Drake,et al.  Assertive Community Treatment for People with Severe Mental Illness , 2001 .

[34]  J. Borum,et al.  Does Involuntary Outpatient Treatment Work , 2001 .

[35]  R. O'Reilly,et al.  A Survey of the Use of Community Treatment Orders by Psychiatrists in Saskatchewan , 2000, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[36]  S. Horgon.  The lived experience of people receiving assertive community treatment: A phenomenological study , 2000 .

[37]  P. Chue,et al.  Hospital Outcome Measures following Assertive Community Treatment in Edmonton, Alberta , 1999, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[38]  Masoud Parsania,et al.  THE PATIENTS , 1982, California state journal of medicine.

[39]  Melbourne Victoria,et al.  A Ministry of Health , 1917, Nature.