Carer involvement in compulsory out-patient psychiatric care in England

Jorun Rugkåsa,Krysia Canvin

doi:10.1186/s12913-017-2716-z

Abstract

BackgroundThere is an expectation in current heath care policy that family carers are involved in service delivery. This is also the case with compulsory outpatient mental health care, Community Treatment Orders (CTOs) that were introduced in England in 2008. No study has systematically investigated family involvement through the CTO process.MethodWe conducted qualitative interviews with 24 family carers to ascertain their views and experiences of involvement in CTOs. The transcripts were subjected to thematic analysis that incorporated both deductive and inductive elements.ResultsWe found significant variation in both the type and extent of family carer involvement throughout the CTO process (initiation, recall to hospital, renewal, tribunal hearings, discharge). Some were satisfied with their level of involvement while others felt (at least partly) excluded or that they wanted to be more involved. Some wanted less involvement than what they had. From the interviews we identified key factors shaping carers' involvement. These included: perceptions of patient preference; concern over the relationship to the patient; carers’ knowledge of the CTO and of the potential for carer involvement; access to and relationships with health professionals; issues of patient confidentiality; opportunities for private discussions, and; health professionals limiting involvement. These factors show that health professionals have many opportunities to facilitate, or hinder, carer involvement. The various roles attributed to carers, such ‘proxy’ for patient decision, ‘gatekeeper’ to services, ‘mother’ or ‘expert carer’, however, conflict with one another and make the overall role unclear.ConclusionsThere is a need for clarification of the expectations of carers in individual care situations, for carers to be equipped with the information they need to in order to be involved, and for services to find flexible and innovative ways of ensuring continuous, open communication. The introduction of CTOs in England has not been successful in its ambition for carer involvement.

Highlights

There is an expectation in current heath care policy that family carers are involved in service delivery
From the interviews we identified key factors shaping carers' involvement
These included: perceptions of patient preference; concern over the relationship to the patient; carers’ knowledge of the Community Treatment Order (CTO) and of the potential for carer involvement; access to and relationships with health professionals; issues of patient confidentiality; opportunities for private discussions, and; health professionals limiting involvement. These factors show that health professionals have many opportunities to facilitate, or hinder, carer involvement

Summary

Introduction

There is an expectation in current heath care policy that family carers are involved in service delivery This is the case with compulsory outpatient mental health care, Community Treatment Orders (CTOs) that were introduced in England in 2008. Carers’ role in coercion in outpatient mental health services A role for family carers in the planning and execution of formal compulsion has long been established and is usually written into mental health legislation This is often in the capacity of ‘ of Kin’ which entails certain rights to initiate or end involuntary treatment. Three partly overlapping roles for carers have been identified in mental health legislation They may act as ‘gatekeepers’ who monitor patients and decide when professional intervention (including compulsion) is required. This can sometimes place family members in adversarial positions vis-à-vis each other [9, 10]

Methods

Results

Conclusion