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International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2014

Open Access 01-12-2014 | Research

Community treatment orders and the experiences of ethnic minority individuals diagnosed with serious mental illness in the Canadian mental health system

Author: Magnus Mfoafo-M’Carthy

Published in: International Journal for Equity in Health | Issue 1/2014

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Abstract

Introduction

The prevalence of Community Treatment Orders (CTOs) in the Western world has generated considerable discussion regarding best practices in the outpatient treatment of the seriously mentally ill. Although problems encountered by ethnic minority communities in the various health care systems have been studied to some degree, there is an acute dearth of information on the effects of CTOs on minority individuals. This paper presents findings from research on the lived experiences of individuals from ethnic minority backgrounds who have been the subjects of CTOs in Toronto, Canada, and their perceptions of its impact on their lives.

Methods

Using a qualitative phenomenological approach, in-depth semi-structured interviews were conducted with individuals who have experienced CTOs. Purposive sampling was used to recruit participants (n =24) from ethnic minority background in Toronto, Canada.

Results

Participants perceived both positive and negative impacts of CTOs. The positives included affirmation of experiences with the mental health system; improved rapport with the case management and clinical team, increased medication compliance and feelings of empowerment. The negative feedback included feelings of being coerced and the stigma associated with it.

Conclusions

The findings of this study suggest that although CTOs are not a panacea for every mental health problem, they can be effective with a specific group who choose to follow through with the expectations of the treatment. The author, however argues that for these individuals to be on a CTO before getting better treatment, brings to the fore a number of issues with the mental health system. This is particularly concerning as it pertains to individuals of ethnic minority background.
Literature
1.
Bhui K, Stansfeld S, McKenzie K, Karlsen S, Nazroo J, Weich S: Racial/ethnic discrimination and common mental disorders among workers: findings from the EMPRIC study of ethnic minority groups in the United Kingdom. Am J Public Health. 2005, 95: 496-501. 10.2105/AJPH.2003.033274.PubMedCentralPubMedCrossRef
2.
Noh S, Kaspar V: Perceived discrimination and depression: moderating effects of coping, acculturation, and ethnic support. Am J Public Health. 2003, 93: 232-238. 10.2105/AJPH.93.2.232.PubMedCentralPubMedCrossRef
3.
Ojed VD, Bergstresser SM: Gender, race-ethnicity and psychosocial barriers to mental health care: an examination of perceptions and attitudes among adults reporting unmet need. J Health Soc Behav. 2008, 48: 317-334. 10.1177/002214650804900306.CrossRef
4.
Wamala S, Bostrom G, Nyqvist K: Perceived discrimination and psychological distress in Sweden. British J Psychiatr. 2007, 190: 75-76. 10.1192/bjp.bp.105.021188.CrossRef
5.
Wang PS, Lane M, Olfson M, Pincus HA, Well KB, Kessler RC: Twelve-month use of mental health services in the United States. Arch Gen Psychiatry. 2005, 62: 629-640. 10.1001/archpsyc.62.6.629.PubMedCrossRef
6.
Williams CC: Ethical considerations in mental health research with racial and ethnic minority communities. Community Ment Health J. 2005, 41 (5): 509-519. 10.1007/s10597-005-6358-y.PubMedCrossRef
7.
McKenzie K, Bhui K: Institutional racism in mental health care. Br Med J. 2007, 334 (7595): 649-650. 10.1136/bmj.39163.395972.80.CrossRef
8.
Tinsley-Jones H: Racism: calling a spade a spade. Psychother. 2003, 40 (3): 179-186. 10.1037/0033-3204.40.3.179.CrossRef
9.
Tsang AKT, Bogo M, George U: Critical issues in cross-cultural counselling research: case example of an ongoing project. J Multi-Cultural Counsel Dev. 2003, 31 (1): 63-78. 10.1002/j.2161-1912.2003.tb00532.x.CrossRef
10.
Community treatment orders on the increase, finds review of act. MHP. 2012, 15: 10-11.
11.
Mfoafo-M’Carthy M: “Experience is the Best Teacher”. In Community Treatment Orders (CTOs) among Ethno-Racial Minority Communities in Toronto: A Phenomenological Study. Toronto, Canada: University of Toronto; 2010. Unpublished doctoral dissertation.
12.
Bhugra D, Ayonrinde O: Racism, Racial life events and Mental Health. Advances in Psychiatric Treatment. 2001, 7: 343-349. 10.1192/apt.7.5.343.CrossRef
13.
Anderson NB, Armstead CA: Toward understanding the association of socioeconomic status and health: a new challenge for the bio-psychosocial approach. Psychosom Med. 1995, 23: 3726-3751.
14.
Anderson NB, McNeilly M, Myers H: Autonomic reactivity and hypertension in Blacks: a review and proposed model. Ethn Dis. 1991, 1: 154-170.PubMed
15.
Essed P: Everyday racism: Reports from women of two cultures. 1990, Hunter House Inc, Claremont, CA
16.
Williams DR, Collins C: US socio-economic and racial differences in health. patterns and explanations. Annu Rev Sociol. 1995, 21: 349-386. 10.1146/annurev.so.21.080195.002025.CrossRef
17.
Mullaly B: Challenging Oppression and Confronting Privilege. 2010, Oxford University Press, Don Mills, Ontario
18.
Thompson-Miller R, Feagin JR: Continuing injuries of racism: counseling in a racist context. Counsel Psychol. 2007, 35: 106-115. 10.1177/0011000006294664. doi:10.1177/0011000006294664CrossRef
19.
Manseau M, Case B: Racial-ethnic disparities in outpatient mental health visits to U.S. Physicians, 1993-2008.Psychiatr Serv Advance 2013, doi:10.1176/appi.ps.201200528 accessed October 30, 2013.,
20.
McKenzie K, Semele C, Van Horn E, Tattan T, Van Os J, Murray R: Comparison of the outcome and treatment of psychosis in people of the Caribbean origin living in the UK and British Whites. report from the UK700 trial. British J Psychiatr. 2001, 178: 160-165. 10.1192/bjp.178.2.160.CrossRef
21.
Mental health: Culture, race, ethnicity – A supplement to mental health: A report of the surgeon-general. Rockvile, MD: US Department of Health Services Administration, Centre for Mental Health Services, National Institutes of Health, National Institute of Mental Health;, Rockvile, MD
22.
Williams CC: A rationale for an anti-racist entry point to anti-oppressive social work in mental health services. Crit Soc Work. 2002, 2 (2): 20-31.
23.
Nelson CA: Of eggshells and thin-skulls: a consideration of racism-related mental illness impacting Black women. Int J Law Psychiatry. 2006, 29: 112-136. 10.1016/j.ijlp.2004.03.012.PubMedCrossRef
24.
25.
Mullen R, Gibbs A, Dawson J: Family perspective on community treatment orders: a New Zealand study. Int J Soc Psychiatr. 2006, 52 (5): 469-478. 10.1177/0020764006066836.CrossRef
26.
Torrey FE, Zdanowicz M: Outpatient commitment: What, why, and for whom?. Psychiatr Serv. 2001, 52 (3): 337-341. 10.1176/appi.ps.52.3.337.PubMedCrossRef
27.
28.
O’Reilly RL, Keegan DL, Elias JW: A survey of the use of community treatment orders by psychiatrists in Saskatchewan. Can J Psychiatry. 2000, 45: 79-81.PubMed
29.
Romans S, Dawson J, Mullen R, Gibbs A: How mental health clinicians view community treatment orders: a New Zealand survey. Australian and New Zealand J Psychiatr. 2004, 38: 836-841. 10.1080/j.1440-1614.2004.01470.x.CrossRef
30.
Swanson JW, Swartz JW, Elbogen EB, Wagner HR, Burns BJ: Effects of involuntary outpatient commitment on subjective quality of life in persons with severe mental illness. Behav Sci Law. 2003, 21 (4): 473-491. 10.1002/bsl.548.PubMedCrossRef
31.
32.
33.
Mfoafo-M’Carthy M, Williams CC: Coercion and Community Treatment Orders (CTOs): one step forward, two steps back?. Can J Commun Ment Health. 2010, 29 (1): 69-80.CrossRef
34.
Swartz MS, Wagner HR, Swanson JW, Elbogen EB: Consumers’ perceptions of the fairness and effectiveness of mandated community treatment and related pressures. Psychiatr Serv. 2004, 55 (7): 780-785. 10.1176/appi.ps.55.7.780.PubMedCrossRef
35.
Szigeti A: Ontario’s Community Treatment Orders: how did we get there and where do we go now? an advocate’s perspective. Health Law Canada. 2001, 21 (3): 66-83.
36.
37.
Gibbs A, Dawson J, Forsyth H, Mullen R: Maori experience of CTOs in Otago, New Zealand. Australian and New Zealand J Psychiatr. 2004, 38 (10): 830-835. 10.1080/j.1440-1614.2004.01468.x.CrossRef
38.
39.
Creswell JW: Qualitative Inquiry and Research Design, Choosing Among Five Approaches. 2013, Sage, Thousand Oaks, California
40.
Moustakas C: Phenomenological research methods. 1994, Sage, Thousand Oaks, CA
41.
Muirhead D, Harvey C, Ingram G: Effectiveness of CTOs for treatment of schizophrenia with oral or depot antipsychotic medication: clinical outcomes. Australian & New Zealand Psychiatr. 2006, 40 (6-7): 596-605. 10.1080/j.1440-1614.2006.01844.x.CrossRef
42.
Swartz MS, Swanson JW, Wagner HR, Burns BJ, Hiday VA: Effects of involuntary outpatient commitment and depot antipsychotics on treatment adherence in persons with severe mental illness. J Nerv Ment Dis. 2001, 189 (9): 583-592. 10.1097/00005053-200109000-00003.PubMedCrossRef
43.
Vaughn K, McConghy N, Wolf C, Myhr C, Black T: Community treatment orders: relationship to clinical care, medication compliance, behavioural disturbance and readmission. Australian & New Zealand J Psychiatr. 2000, 34: 801-808. 10.1080/j.1440-1614.2000.00813.x.CrossRef
44.
Bhabha HK: The location of Culture. 2004, Routledge, London
45.
Linhorst DM: Empowering People with Severe Mental Illness. A Practical Guide. 2006, Oxford University Press, New York
46.
Elbogen EB, Swanson JW, Swatz MS: Effects of legal mechanisms on perceived coercion and treatment adherence among persons with severe mental illness. J Nerv Ment Dis. 2003, 191 (10): 629-637. 10.1097/01.nmd.0000092195.22555.12.PubMedCrossRef
47.
Hiday VA, Scheid-Cook TL: Outpatient commitment for “revolving door” patients: compliance and treatment. J Nerv Ment Dis. 1991, 1991 (179): 83-88. 10.1097/00005053-199102000-00004.CrossRef
Metadata
Title
Community treatment orders and the experiences of ethnic minority individuals diagnosed with serious mental illness in the Canadian mental health system
Author
Magnus Mfoafo-M’Carthy
Publication date
01-12-2014
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2014
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-014-0069-3

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