Making sense of a Community Treatment Orders: An Interpretative Phenomenological Analysis.

Community Treatment Orders (CTOs) are now an increasingly common feature of mental health treatment in England and Wales. However, the use of CTOs remains contentious and although compulsory community treatment is used in many countries, there is a lack of supportive evidence, which is often characterised by methodological weaknesses and conflicting results. The few qualitative studies that have been undertaken reveal wide variations in service-user experience and understanding. As a consequence researchers have repeatedly called for research that seeks to make sense of CTOs from a service-user perspective. This qualitative study uses Interpretative Phenomenological Analysis (IPA) to guide data collection and analysis. Ten active CTO service-users were recruited from an Assertive Outreach Team caseload with each participant agreeing to undertake one or two semi-structured interviews (18 interviews in all) with photo-journals and diaries used to support the narrative and help elicit responses. From the IPA data set, open codes, themes and clusters were developed that organised participant experience into three typologies grouped under the headings of oppressed, challenged and relieved responses. Further analysis, initial discussion and comparison with extant literature identified theoretical approaches that resonated and combined with the new findings. A conceptual model is now being developed that may inform and guide practitioners towards more effective future interventions.