Service users' perceptions of Community Treatment Orders and their impact on interpersonal relationships.

Section A is a review of the literature on Community Treatment Orders (CTOs) in the context of their recent introduction in England and Wales. A critical review of the literature in relation to CTOs’ effectiveness is presented, followed by available evidence on service users’ perceptions of CTOs. Consideration of ethical issues that surround compulsory community treatment is also offered. The review highlights gaps in the literature regarding CTOs’ impact on service users’ interpersonal relationships and on how service users who are based in the UK perceive CTOs. Further qualitative research is recommended. Section B describes a qualitative study investigating male service users’ perceptions of their CTOs and the impact of this intervention on their interpersonal relationships. Grounded Theory was used to analyse interview data from 15 participants. Five higher-order categories and 15 categories were identified which contributed to a preliminary model of how service users develop their CTO perceptions. The factors that appeared to influence participants’ perceptions of their CTOs were: i) past and present social living conditions, ii) view of self in relation to mental health, iii) view of the CTO service, i.e. view of medication and mental health professionals. Finally, the model showed that CTOs had a limited or no impact on participants’ views of their relationships with their families, friends, partners and local communities. Results are discussed with reference to potentially relevant psychological theories. Clinical implications, including raising professionals’ awareness about the impact of coercion on the therapeutic relationship, and directions for future research are also presented. Section C is a critical appraisal of the study presented in Section B. It provides reflective responses to four questions in relation to the following areas: research skills acquired through conducting the study; what improvements could be made if repeating the study; clinical implications; and directions for future research