Abstract
Background The Mental Health (Care and Treatment) (Scotland) Act 2003 was considered as world leading when it was enacted due to its rights-based approach. Changes were made to encourage participation and enhance autonomy, including the Mental Health Tribunal for Scotland (the tribunal) replacing the Sheriff Court in making decisions about compulsory treatment. Aims To explore the views of individuals on community based compulsory treatment orders (CCTOs) and independent advocates to assess whether participation in the tribunal is perceived as meaningful in practice. Method A qualitative research design was adopted and semi-structured interviews were undertaken with 19 people with experience of being on a CCTO and eight mental health advocates in Scotland. The data were thematically analysed and explored using ethics of care principles. Results Individuals faced barriers to participation, including mental distress, medication, and inaccessible communication, and both the tribunal process and outcome were important in shaping perceptions of fairness. A perceived unsuccessful outcome was found to undermine an ostensibly participatory process, and unequal power dynamics resulted in feelings of powerlessness. Conclusions The findings suggest that participation is often experienced as tokenistic in practice and that cultural change is required if people are to be meaningfully involved in tribunal proceedings.
Highlights
The participation of people experiencing mental distress in processes that affect their lives is a well-established policy requirement in various countries across the world (Bee et al, 2015; Beresford, 2013; Gee et al, 2016; Happell, 2008; Ocloo & Matthews, 2016)
This paper draws upon semi-structured interviews undertaken with 19 individuals who had been on a community based compulsory treatment orders (CCTOs) and eight mental health advocates6
Individuals’ on CCTOs, identified a range of barriers that restricted their involvement, including those arising from mental distress
Summary
The participation of people experiencing mental distress in processes that affect their lives is a well-established policy requirement in various countries across the world (Bee et al, 2015; Beresford, 2013; Gee et al, 2016; Happell, 2008; Ocloo & Matthews, 2016) This reflects a shift from paternalistic practices towards more collaborative decision-making, including greater engagement in areas such as care planning, policy development, research, and service commissioning (Farrelly et al, 2016; Weinstein, 2010). Conclusions: The findings suggest that participation is often experienced as tokenistic in practice and that cultural change is required if people are to be meaningfully involved in tribunal proceedings
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