Use of compulsory community treatment in mental healthcare: An integrative review of stakeholders’ opinions

Abstract

BackgroundMultiple studies have examined the effects of compulsory community treatment (CCT), amongst them there were three randomized controlled trials (RCT). Overall, they do not find that CCT affects clinical outcomes or reduces the number or duration of hospital admissions more than voluntary care does. Despite these negative findings, in many countries CCT is still used. One of the reasons may be that stakeholders favor a mental health system including CCT.AimThis integrative review investigated the opinions of stakeholders (patients, significant others, mental health workers, and policy makers) about the use of CCT.MethodsWe performed an integrative review; to include all qualitative and quantitative manuscripts on the views of patients, significant others, clinicians and policy makers regarding the use of CCT, we searched MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science Core Collection, Cochrane CENTRAL Register of Controlled Trials (via Wiley), and Google Scholar.ResultsWe found 142 studies investigating the opinion of stakeholders (patients, significant others, and mental health workers) of which 55 were included. Of these 55 studies, 29 included opinions of patients, 14 included significant others, and 31 included mental health care workers. We found no studies that included policy makers. The majority in two of the three stakeholder groups (relatives and mental health workers) seemed to support a system that used CCT. Patients were more hesitant, but they generally preferred CCT over admission. All stakeholder groups expressed ambivalence. Their opinions did not differ clearly between those who did and did not have experience with CCT. Advantages mentioned most regarded accessibility of care and a way to remain in contact with patients, especially during times of crisis or deterioration. The most mentioned disadvantage by all stakeholder groups was that CCT restricted autonomy and was coercive. Other disadvantages mentioned were that CCT was stigmatizing and that it focused too much on medication.ConclusionStakeholders had mixed opinions regarding CCT. While a majority seemed to support the use of CCT, they also had concerns, especially regarding the restrictions CCT imposed on patients’ freedom and autonomy, stigmatization, and the focus on medication.

Evidence synthesis on coercion in mental health: An umbrella review

“…The final synthesis included 46 articles, of which some were systematic reviews (n = 36, 29 of which were qualitative syntheses) and others were systematic reviews, including meta-analyses (n = 10). Most had been published in the previous 5 years and in English, except for one article published in Dutch (De Waardt & van der Heijden, 2017), one in German (Rabe et al, 2017), one in Norwegian (Dahm et al, 2017) and one in French (Pariseau-Legault et al, 2020). Articles originally published in Dutch, German and French were translated into English using DeepL Pro.…”

“…Six reviews focusing on CTOs were included in our analysis, and all set out to update the available evidence or examine its effectiveness (Barnett et al, 2018;De Waardt & van der Heijden, 2017;Kisely, 2016;Kisely et al, 2017;Kisely & Hall, 2014;Maughan et al, 2014). Three of the reviews included a meta-analysis (Barnett et al, 2018;Kisely et al, 2017;Kisely & Hall, 2014).…”

“…Regarding CTOs, it is noteworthy that doctors working in community mental health identified certain benefits in their application, such as greater clinical stability or better quality of life, generally professing themselves to be in favour of this approach (Corring et al, 2018;De Waardt & van der Heijden, 2017;Kisely, 2016) and concluding that CTOs are necessary under certain circumstances. On the other hand, professional dissonance between their support of an imposed treatment regimen and the principles of recovery and person-centred care attention caused a conflict of principles and personal unease, without forgetting the associated deterioration of the therapeutic relationship (Corring et al, 2018).…”

“…On the other hand, professional dissonance between their support of an imposed treatment regimen and the principles of recovery and person-centred care attention caused a conflict of principles and personal unease, without forgetting the associated deterioration of the therapeutic relationship (Corring et al, 2018). Family caregivers were also often in favour (Kisely, 2016) of this measure, while users could be either in favour (De Waardt & van der Heijden, 2017) or ambivalent towards it (Kisely, 2016).…”

Compulsory community treatment orders (CTOs): recent research and future directions

“…Patients find them stigmatising, they may experience adverse drug reactions and coercive treatment may discourage help-seeking. 1 Consequently, if we are to continue using CTOs it is important to understand the range of outcomes associated with their use.…”