Patients experiencing compulsory community care
The paper presents findings from an ongoing project concerning compulsory community care (CCC) in Sweden. CCC was introduced in 2008 following a series of incidents of assault involving people with mental illness that were widely reported in mass media. The stated purpose of CCC, however, is to facilitate the transfer of inpatients to community care. CCC can only be initiated following compulsory inpatient care after an application to an administrative court from the treating psychiatrist. CCC typically involves coordination between psychiatry and social services, where the latter often are responsible for the day-to-day engagement with the patient.
Throughout the world, CCC has been controversial because it involves new ethical questions. For example, coercive measures may be invoked over longer time periods and they infringe into new and more private spheres of citizens. On an organizational level, it requires improved cooperation between health and social service providers.
The objective of this paper is to investigate the experiences of patients subjected to CCC. Three aspects of experiences are focused: 1) what is the everyday life experience of being under CCC? 2) How is being under CCC different from other forms of voluntary and involuntary care? 3) How is CCC affecting the ways in which compliance is achieved?
20 qualitative interviews are carried out with patients with prior or current experience of CCC (10 forensic, 10 civil). Interviewees are selected with the ambition to achieve variation in gender, ethnicity, diagnosis, age and type of housing. In addition, two group interviews with relatives to patients are carried out.
Interviews will revolve around topics such as previous experience of formal and informal coercion, court proceedings, information from service providers, relations to professionals, perceptions of being coerced and a general evaluation of CCC. At this stage, data indicate that patients have little knowledge and understanding of the formal rules surrounding CCC. They appear to comply with medication and other provisions because of a misconception that they otherwise would be recalled to hospital
The paper will explore whether the everyday perception of coercion is different with the new legislation compared to the use of long-term leave from hospital care that was applied prior to 2008. The rules about recall to inpatient care for patients under CCC have been criticized for being toothless: even if patients refrain from abiding to the special provisions set up by the court, it might be difficult to recall. From quantitative data we already know that very few patients are recalled. Nevertheless, preliminary data indicate that clinicians believe that CCC works while patients feel that they are under an obligation to abide to special provisions. The paper to explores the mechanism which induce compliance despite the relatively weak powers to enforce the treatment proposed by the treating psychiatrist.
The project is funded by the Swedish Research Council for Working Life and Social Research.
2011. Vol. 38, no Suppl. 1
IXth International Conference of the European Network for Mental Health Service Evaluation (ENMESH), Ulm, Germany, 23-25, June 2011
Meeting abstract: IXth International Conference of the European Network for Mental Health Service Evaluation (ENMESH), Ulm, Germany, 23-25, June 2011