Experiences with legally mandated treatment in patients with schizophrenia: A systematic review of qualitative studies

Abstract

Background: Patients with severe mental illness, including schizophrenia, may be legally mandated to undergo psychiatric treatment. Patients’ experiences in these situations are not well characterized. This systematic review of qualitative studies aims to describe the experiences of patients with schizophrenia and related disorders who have undergone legally mandated treatment. Methods: Four bibliographic databases were searched: CINAHL Plus (1981–2019), EMBASE (1947–2019), MEDLINE (1946–2019), and PsycINFO (1806–2019). These databases were searched for keywords, text words, and medical subject headings related to schizophrenia, legally mandated treatment and patient experience. The reference lists of included studies and systematic reviews were also investigated. The identified titles and abstracts were reviewed for study inclusion. A thematic analysis was completed for the synthesis of positive and negative aspects of legally mandated treatment. Results: A total of 4,008 citations were identified. Eighteen studies were included in the final synthesis. For the thematic analysis, results were collated under two broad themes; positive patient experiences and negative patient experiences. Patients were satisfied when their autonomy was respected, and dissatisfied when it was not. Patients often retrospectively recognized that their treatment was beneficial. Furthermore, negative aspects of the treatment included deficits in communication and a lack of information. Conclusions: Intervention research has historically focused on clinical outcomes and the quantitative aspects of treatment. Thus, this study provides insight into the qualitative aspects of patients’ experiences with legally mandated treatment. Recognizing these opinions and experiences can lead to better attitudes toward treatment for patients with schizophrenia and related psychiatric illnesses.

A qualitative meta-synthesis of service users’ and carers’ experiences of assessment and involuntary hospital admissions under mental health legislations: a five-year update

“…The finding that service users’ views on therapeutic benefit were mixed mirrors previous findings with service users’ groups of varying diagnoses (e.g. (59, 60, 61). In our review, service users reflected positively on being listened to, experiencing flexibility, being offered options.…”

The benefits and harms of community treatment orders for people diagnosed with psychiatric illnesses: A rapid umbrella review of systematic reviews and meta-analyses

“…Table 3 gives the full list of excluded SRs and the corresponding reasons, while online Supplement 2 contains the full citations. There were 10 papers from 7 SRs of quantitative designs (Barnett et al, 2018;Churchill et al, 2007;Kisely and Hall, 2014;Kisely et al, 2017Kisely et al, , 2021Kisely et al, , 2023Lam et al, 2023;Maughan et al, 2014;Rugkåsa, 2016;Segal, 2020) (Table 3) and 5 of just qualitative studies (Corring et al, 2017(Corring et al, , 2018(Corring et al, , 2019Goulet et al, 2020;Plahouras et al, 2020) (Table 4). Two SRs presented both types of data, although the majority of the studies were qualitative (de Waardt et al, 2022;Pridham et al, 2016) (Table 4).…”

“…Three papers by the same authors reported on the experiences of people on CTOs, clinicians and family, respectively ( Corring et al, 2017 , 2018 , 2019 ), while two other studies reported on all three groups in the same paper ( de Waardt et al, 2022 ; Goulet et al, 2020 ). Two studies reported only on the experiences of people on CTOs ( Plahouras et al, 2020 ; Pridham et al, 2016 ). People on CTOs reported mixed feelings about being on compulsory community treatment in all the studies ( Table 3 ).…”

“…However, these benefits came at a cost. Most commonly, this was a lack of self-determination and control over treatment for people made subject to CTOs ( Corring et al, 2017 ; de Waardt et al, 2022 ; Plahouras et al, 2020 ). Importantly, coercion was a key barrier to building a therapeutic relationship with professionals while the person was on a CTO ( Goulet et al, 2020 ).…”

“…Similarly, family members and supporters generally described CTOs as facilitating access to care and felt that they were more frequently recognised by clinicians as having an important role when a person was on a CTO ( de Waardt et al, 2022 ; Corring et al, 2019 ). Families consequently viewed CTOs as a way to have their thoughts, feelings and perspectives considered ( Corring et al, 2019 ; Plahouras et al, 2020 ).…”