Assessments of need for treatment and danger in decisions about community treatment orders

Abstract

BackgroundA total of, 14 Norwegian assertive community treatment (ACT) teams have been established. During the teams’ first year of operation, approximately 35% of the enrolled patients were subjected to community treatment orders (CTOs) at intake. CTOs are a legal mechanism to secure treatment adherence, and may be used in Norway when severely mentally ill patients refuse necessary treatment (‘treatment criterion’) or when they are considered a danger to themselves or others (‘danger criterion’). Even if the use of CTOs seems to increase in Norway, few have examined in detail how and why these decisions are made. The purpose of the present study was to explore assessments of need for treatment and danger in decisions about CTOs.MethodSemi-structured interviews with eight responsible clinicians and four focus-group interviews with 20 ACT providers were recorded and transcribed. We also read case files and observed selected treatment planning meetings. The data were analyzed with a modified grounded theory approach.ResultsThe ACT teams provided high-intensive services over longer periods of time, which gave the teams important knowledge about the patients, reduced clinical uncertainty, and allowed for well-informed decisions about the need for coercive interventions. The treatment criterion was typically used to justify the need for CTOs. However, the danger criterion was in some cases used when patients had to be readmitted to hospital.ConclusionsAccording to the clinicians that were interviewed, patients’ need for treatment was most often used to justify the CTOs in the Norwegian ACT teams.