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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Psychiatry | doi: 10.3389/fpsyt.2019.00349

Trust and community treatment orders

 John McMillan1, 2*,  Sharon Lawn3 and Toni Delany-Crowe4
  • 1University of Otago, New Zealand
  • 2Bioethics Centre, Dunedin School of Medicine, University of Otago, New Zealand
  • 3Flinders Human Behaviour and Health Research Unit, Flinders University, Australia
  • 4Flinders University, Australia

There are conflicting views about the benefits of community treatment orders (CTOs) for people with mental illness. While there is a significant literature on the coercive nature of CTOs, there is less on the impact that CTOs have upon trust. A recovery-oriented approach requires a trusting therapeutic relationship and the coercion inherent in the CTO process may make it difficult for trust to be built, nurtured and sustained between workers and patients. Our aim was therefore to examine the role of trust within the CTO experience for mental health workers and patients on CTOs.
Methods: We conducted a thematic discourse analysis of eight in-depth interviews with people who were currently on a CTO and 10 interviews with multi-disciplinary mental health workers in Adelaide, Australia (total N=18 interviews). The interviews were coded and analysed with the assistance of a patient representative. The findings reveal the challenges and opportunities for trust within the coercive relationship of a CTO.
Findings: We found that patients have diverse experiences of CTOs and that trust or mistrust played an import role in whether or not they found the CTO beneficial.

Keywords: Community treatment orders, Vulnerability, Trust, Recovery, Engagement (involvement), Coercion, Luhmann Niklas

Received: 12 Nov 2018; Accepted: 02 May 2019.

Edited by:

Christian Huber, University Psychiatric Clinic Basel, Switzerland

Reviewed by:

Anke Maatz, University of Zurich, Switzerland
Jorun Rugkåsa, Akershus University Hospital, Norway  

Copyright: © 2019 McMillan, Lawn and Delany-Crowe. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. John McMillan, University of Otago, Dunedin, New Zealand,