Abstract
BackgroundThe first 12 Norwegian assertive community treatment (ACT) teams were piloted from 2009 to 2011. Of the 338 patients included during the teams’ first year of operation, 38% were subject to community treatment orders (CTOs). In Norway as in many other Western countries, the use of CTOs is relatively high despite lack of robust evidence for their effectiveness. The purpose of the present study was to explore how responsible clinicians reason and make decisions about the continued use of CTOs, recall to hospital and the discontinuation of CTOs within an ACT setting.MethodsSemi-structured interviews with eight responsible clinicians combined with patient case files and observations of treatment planning meetings. The data were analysed using a modified grounded theory approach.ResultsThe participants emphasized that being part of a multidisciplinary team with shared caseload responsibility that provides intensive services over long periods of time allowed for more nuanced assessments and more flexible treatment solutions on CTOs. The treatment criterion was typically used to justify the need for CTO. There was substantial variation in the responsible clinicians’ legal interpretation of dangerousness, and some clinicians applied the dangerousness criterion more than others.ConclusionsAccording to the clinicians, many patients subject to CTOs were referred from hospitals and high security facilities, and decisions regarding the continuation of CTOs typically involved multiple and interacting risk factors. While patients’ need for treatment was most often applied to justify the need for CTOs, in some cases the use of CTOs was described as a tool to contain dangerousness and prevent harm.
Highlights
The first 12 Norwegian assertive community treatment (ACT) teams were piloted from 2009 to 2011
In our analysis, we identified three main categories that reflected the overall finding ‘feeling more confident and secure through shared responsibility’: (1) community treatment order (CTO) as a tool for achieving patient stability and safety, (2) CTO as a tool for containing dangerousness and preventing harm, and (3) CTO and ACT allowing for more nuanced judgments and reduced coercion
The participants emphasized that CTOs were mainly founded on patients’ clinical needs, and that establishing stability and safety for patients enrolled in ACT is often a lengthy process
Summary
The first 12 Norwegian assertive community treatment (ACT) teams were piloted from 2009 to 2011. In Norway, as in many other Western countries, there has been a substantial reduction in the number of inpatient beds and a move towards community-based services, referred to as a ‘deinstitutionalization’ of psychiatric care [1, 2]. As part of this process of deinstitutionalization, the primary locus of treatment of severe mental illness (SMI) shifted from hospitals to the community. Different legal mechanisms, such as community treatment orders (CTOs), have been used to compel treatment adherence in more than 75 jurisdictions worldwide [3]. If extended commitment after the initial 12 months is requested, the Supervisory Commission makes an independent review
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
