Lines of resistance: Exploring professionals' views of compulsory community supervision

Abstract

Proposals to reform the Mental Health Act 1983 include the introduction of powers to compulsorily treat patients living in the community. In this study, we assess mental health professionals' attitudes towards two current measures (Supervised Discharge Orders (SDOs) and Guardianship), which enable legal requirements to be imposed upon mentally disordered people in the community. Clear differences in professional attitudes towards these measures were recorded, and resistance to their use was based upon both pragmatic decision-making and philosophical objections. In general, social care professionals hold more positive views of both SDOs and Guardianship than health care professionals. All professional groups rate Guardianship, which emphasises patient welfare, more highly than SDOs, and psychiatrists are most in favour of introducing additional powers to enforce medication compliance in the community. Resistance to compulsory community supervision appears to be connected to the absence of training and direct experience of the powers. Negative attitudes towards mental health legislation are shared between colleagues.