The introduction of supervised community treatment, delivered through community treatment orders (CTOs) in England and Wales, contrasts with the policy of personalisation, which aims to provide service users autonomy and choice over services. This article draws upon findings from a primarily qualitative study which included 72 semi-structured interviews (conducted between January and December 2012) with practitioners, service users and nearest relatives situated within a particular NHS Trust. The article also refers to a follow-on study in which 30 Approved Mental Health Practitioners were interviewed. The studies aimed to develop a better understanding of how compulsory powers are being used in the community, within a policy context that emphasises personalisation and person-centred care in service delivery. Findings from the interview data (which were analysed thematically) suggest that service users were often inadequately informed about the CTO and their legal rights. Furthermore, they tended to be offered little, or no, opportunity to make choices and have involvement in the making of the CTO and setting of conditions. Retrospectively, however, restrictions were often felt beneficial to recovery, and service users reported greater involvement in decisions at review stage. Areas of good practice are identified through which person-centred care can be better incorporated into the making of CTOs.

The perceptions of service users have an important role in determining the value and potential effectiveness of CTOs. A consideration of these issues should be integral to the process of assessing whether a CTO is appropriate in individual cases.

Data from the International Social Survey Programme (2001) was used to analyse the social networks of older people and whether living in single person households increased the risk of isolation. When comparing respondents with one or more adult children, there was no significant difference in the likelihood of experiencing familial isolation between people living in single person households and those living in larger households. A majority of those living in single person households had at least regular contact with a sibling, adult child or close friend and participated in a social organisation. Friends compensate to some extent for a lack of support from the family, although in southern and eastern European countries, other relatives appeared to be more important in support networks. People living in single person households were more likely to experience isolation, but this was largely related to advanced age and childlessness. Whilst a very small minority in Japan were living in single person households, they were significantly more likely to be severely isolated than those living in single person households in other countries.

This research examined changes in the number of care homes and their residents in the UK between the 1991 and 2001 Censuses. Local-authority-owned provision universally declined in this period, but changes in private residential and nursing homes were far more varied. Some parts of Britain experienced a growth in this market, in particular Scotland. Regions which were traditionally linked with greater numbers of retired people in their populations declined in their private residential home markets (e.g. the South West and South East). Wales experienced a regional decline that was greater than most English regions. Using additional Department of Health data, it was possible to estimate which local authority areas in England were exporting state-funded supported residents to homes out of their area. Most of these authorities were in urban areas and the highest rates of exporting were from Inner London boroughs. Political control and average property prices were explored as possible independent variables influencing the percentage rate of decline in homes in a local authority area. It appeared that Conservative authorities experienced a more rapid decline in government-owned homes than those run by Labour, but the results were not statistically significant, suggesting that local politics was a not a key influence on the trend. Average property prices did not affect all areas of the country, but were found to have a negative and significant association with percentage rates of decline in care homes in both Wales and London.

In recent decades there has been a suggestion that public and private long-term care (LTC) expenditure might be replacing traditional family care for older people. The decline of family contact is known to be more advanced in some OECD countries than others, with southern Europe identified as where family contact is still strong. This article explores at a country level whether there is an association between levels of expenditure on long-term care and the availability of family contacts. Qualitative Comparative Analysis is used as a comparative method, so as to use national quantitative indicators with a small sample of countries. An association between higher levels of family contact and lower levels of expenditure on LTC is suggested, but it is weakened by a number of untypical cases. Countries that defy this relationship have government care policies that seek to promote informal social care through the family contact that continues to be available. Austria, Canada, Great Britain and Japan are discussed in this context.