Examining the use of metaphors to understand the experience of community treatment orders for patients and mental health workers

Sharon Lawn,Toni Delany,Mariastella Pulvirenti,John Mcmillan,Ann Smith

doi:10.1186/s12888-016-0791-z

Sharon Lawn, Toni Delany + Show 3 more

Open Access

https://doi.org/10.1186/s12888-016-0791-z

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Journal: BMC Psychiatry	Publication Date: Mar 31, 2016
Citations: 11	License type: cc-by

Affiliation: Flinders University, University of Otago

Abstract

BackgroundCommunity Treatment Orders (CTOs) are often complex because of the ethical tensions created by an intervention that aims at promoting the patient’s good through an inherently coercive process. There is limited research that examines the complexity of CTOs and how patients on CTOs and workers administering CTOs make sense of their experiences.MethodsThe study involved in-depth interviews with 8 patients on CTOs and 10 community mental health workers in South Australia, to explore how they constructed their experiences of CTOs. Critical discourse analysis (CDA) was used to analyse the data, supported by NVIVO software.ResultsAnalysis of the interviews revealed that patients and workers experienced the CTO process as multi-dimensional, including some positive as well as more negative constructions. The positive metaphor of CTOs as a safety net is described, followed by a more detailed description of the metaphors of power and control as the dominant themes, with five sub-themes of the CTO as control, wake-up, punishment, surveillance, and tranquiliser.DiscussionMetaphors are a way that mental health patients and mental health workers articulate the nature of CTOs. The language used to construct these metaphors was quite different, with patients overwhelmingly experiencing and perceiving CTOs as coercive (that is, punishing, controlling and scrutinizing), whereas workers tended to perceive them as necessary, beneficial and supportive, despite their coerciveness.ConclusionsBy acknowledging the role of metaphors in these patients’ lives, workers could enhance opportunities to engage these patients in more meaningful dialogue about their personal experiences as an alternative to practice predominantly focused on risk. Such a dialogue could enhance workers’ reflection on their work and promote recovery-based practice. More understanding of how to promote autonomy, capacity and supported decision-making, and how to address the impacts of coercion within care, is needed.

Highlights

Community Treatment Orders (CTOs) are often complex because of the ethical tensions created by an intervention that aims at promoting the patient’s good through an inherently coercive process
The data presented in this paper was collected during a qualitative research project that explored the experiences of the CTO process for community-dwelling patients and community mental health workers in one state of Australia
Result Analysis of the interviews revealed that patients and workers experienced the CTO process as multidimensional, including some positive as well as more negative constructions

Summary

Introduction

Community Treatment Orders (CTOs) are often complex because of the ethical tensions created by an intervention that aims at promoting the patient’s good through an inherently coercive process. There is limited research that examines the complexity of CTOs and how patients on CTOs and workers administering CTOs make sense of their experiences. There has been little research, examining how patients and mental health workers construct their roles respectively as recipients and providers of treatment and care, or the meanings they give to their actions within these constructions. There has been little consideration of how patients and mental health workers might use metaphors to make sense of their experiences. This is interesting, given that the concept of recovery is arguably a deeply personal notion involving ideas and experiences that might be difficult to put into words

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Discussion

Conclusion