Working in collaboration with researchers from the Department of Psychiatry, University of Oxford, this project examines a number of treatment pressures that are used in practice to manage the care of people with mental disorders living in community settings. Treatment pressures are commonly used strategies to manage the care of these people in ways that increase their adherence to treatment, and that prevent ‘revolving door’ situations arising whereby patients continually require re-admittance to hospital as their mental health fluctuates over time.
Two kinds of treatment pressure are being studied within this project. The first treatment pressure is a new legal power – the Community Treatment Order (CTO) – which extends compulsory treatment and care outside of psychiatric hospitals and into the community. The second treatment pressure is called ‘leverage’ – the everyday use of threats or offers by practitioners to place positive or negative conditions on the choices that patients able to make about the care and support they receive.
The project has three components: i) how treatment pressures are used in community mental health services, and what patients’ carers’ and practitioners’ attitudes and experiences are towards them; ii) whether these pressures increase treatment adherence and improve clinical outcomes, and iii) whether the use of these pressures is ethically justified. The Ethox Centre is involved mainly in the third of these components, which also involves using evidence collected within the first two empirical components of the project.
This project is supported by a Programme Grant from the National Institute for Health Research.