How Can the Experience of Being on a Community Treatment Order be Understood in Service User Narratives?

Introduction: Community Treatment Orders (CTOs) were introduced in the UK
under the Mental Health Act 2007. Recent data shows that CTOs have been
employed in far greater numbers than the government originally predicted, though
evidence of their benefits remains limited. There has been considerable debate in
the research literature amongst professionals and service user groups about the
ethical concerns related to CTOs. In the light of this, it is important to study the
experience of being on a CTO. This study therefore aimed to explore the impact of
this with service users who were subject to CTOs.
Method: Six service users who had been on a CTO and were living in the
community were recruited from NHS services in England. The views of these
service users were explored in detail through individual interviews. Narrative
analysis was used to investigate how the service users described the impact of the
CTO on their lives and relationships. Particular attention was paid to the influence
of social and political context on these narratives.
Results: Evidence from service users' narratives suggested that they generally held
relatively negative views about their experience of being on a CTO. Few described
benefits of the CTO and none felt their mental health had improved as a result.
While some service users felt the CTO had had little impact on their relationships,
others reported damage to their relationships with professionals and expressed
ongoing anger about the CTO. Opposition to the CTO appeared to be mainly a
result of side effects of medication and fear of recall into hospital.
Discussion: Service users constructed their identities in relation to the dominant
narratives of the medical model, and the counter-narrative of the survivor movement.
This influenced their responses towards the CTO, with different forms of resistance
and compliance noted. Implications of this for research and clinical practice are
discussed.

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