Service user and practitioner experiences of community treatment orders (CTOs)

The study was conducted between July 2011 and December 2012.

The principal research question, developed as part of the ethics approval, was:

What are service user and practitioner experiences of the use of community treatment orders in an environment of social care policy focused on personalised social care service provision?

Responding to the broader context of adult social care provision in England and Wales, the study aims were:

• To understand how compulsory powers are being used in an environment in which practitioners are encouraged and service users expect to be consulted and to exercise choice to a greater extent than previously.
• To understand what social care supports can be drawn on and whether these are affected by being provided in the context of the use of compulsory powers.
• To explore service users’ and practitioners’ experiences of CTOs and identify good practice in relation to assessment for, and management of, CTOs which maximises Service User participation, minimises risk to self and others and reduces the likelihood of hospital re-admission.

The objectives of the study were:

• To explore and identify the reasons for making CTOs and the characteristics (age, gender, ethnicity, diagnosis, mental health history) of those subject to Supervised Community Treatment (SCT).
• To identify the nature of discretionary conditions attached to CTOs, and the extent to which these (and associated care plans), include social care supports and interventions from statutory, voluntary or private services. 
• To explore the practices and processes associated with the assessment of service users for a CTO, the arrangements for implementing this and the associated care plan.
• To explore users’ experiences of CTOs and the choices and support offered and identify user-defined criteria for good practice in this context.
• To identify opportunities and constraints to developing enabling supportive and therapeutic relationships in this context from the perspectives of service users, responsible clinicians, AMHPs, care co-ordinators and social care service providers.
• To review existing evidence available relating to positive and negative outcomes of the use of compulsory community treatment.

The project succeeded in exploring different perspectives on CTOs and identifying improvements to best practice as a result. The research highlighted issues relating to information, advocacy, decision-making, service user involvement, working relationships and support, allowing a fuller and more complex picture of this evolving practice to emerge.