Meaningful participation or tokenism for individuals on community based compulsory treatment orders? Views and experiences of the mental health tribunal in Scotland

Abstract

Background

The Mental Health (Care and Treatment) (Scotland) Act 2003 was considered as world leading when it was enacted due to its rights-based approach. Changes were made to encourage participation and enhance autonomy, including the Mental Health Tribunal for Scotland (the tribunal) replacing the Sheriff Court in making decisions about compulsory treatment.

Aims

To explore the views of individuals on community based compulsory treatment orders (CCTOs) and independent advocates to assess whether participation in the tribunal is perceived as meaningful in practice.

Method

A qualitative research design was adopted and semi-structured interviews were undertaken with 19 people with experience of being on a CCTO and eight mental health advocates in Scotland. The data were thematically analysed and explored using ethics of care principles.

Results

Individuals faced barriers to participation, including mental distress, medication, and inaccessible communication, and both the tribunal process and outcome were important in shaping perceptions of fairness. A perceived unsuccessful outcome was found to undermine an ostensibly participatory process, and unequal power dynamics resulted in feelings of powerlessness.

Conclusions

The findings suggest that participation is often experienced as tokenistic in practice and that cultural change is required if people are to be meaningfully involved in tribunal proceedings.

Keywords:

• Mental health tribunals
• community-based compulsory treatment orders
• participation
• rights

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 In Scotland, CTOs can be either hospital based or community-based orders and these are termed compulsory treatment orders rather than community treatment orders. CCTOs refers to community based compulsory treatment orders.

2 This takes multiple forms and includes community treatment orders, community based compulsory treatment orders, and involuntary treatment orders.

3 The named person replaced the nearest relative, who had powers in relation to detention and discharge. It is important to note that the named person’s views are independent of the individuals and therefore can diverge.

4 This is based on point prevalence in January 2010 and January 2019.

5 Tribunal panels consist of a medical, general (individuals with relevant lived experience of mental distress and the mental health system or professional experience), and legal member.

6 The wider study also included family members, however the data is not presented here.

7 Whilst there were significantly more male participants, men are more likely to be placed on CCTOs in Scotland.

8 Not all participants agreed with their diagnosis.

9 Individuals from the CCTO group were assigned a pseudonym whilst advocates were provided with an identifier based on the format A (for advocate) followed by a number.

10 RMOs are Responsible Medical Officers.

11 MHOs are mental health officers who are specially trained social workers responsible for supporting people who are subject to the 2003 Act.

12 The convenor is the legal member.

13 This is one of the legislative criteria that must be fulfilled for compulsory treatment to be authorised in Scotland.

14 Akathisia and tardive dyskinesia are movement disorders that are caused by medication.

Additional information

Funding

This work was funded by the Economic and Social Research Council (ESRC) under Grant [1507915].