ArticleBMC health services research2018
Responsibilities with conflicting priorities: a qualitative study of ACT providers' experiences with community treatment orders.
Article in BMC health services research, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
6 citing papers in PubMed, 11 citations in OpenAlex.
- Psychiatric Risk Governance Across Jurisdictions: A Comparative Analysis of Involuntary Treatment, Community Treatment Orders, and Forensic Mental Health Services.Healthcare (Basel, Switzerland) · 2025Review
- Perceiving Ethical Discomfort Triggered by Situations that Resist Meaning in Community Mental Health Settings: A Grounded Theory.Community mental health journal · 2025Article
- The relationship between area levels of involuntary psychiatric care and patient outcomes: a longitudinal national register study from Norway.BMC psychiatry · 2023Article
- Use of compulsory community treatment in mental healthcare: An integrative review of stakeholders' opinions.Frontiers in psychiatry · 2022Review
- Cooperation in the mental health treatment of patients with outpatient commitment.SAGE open medicine · 2020Article
- How clinicians make decisions about CTOs in ACT: a qualitative study.International journal of mental health systems · 2018Article
Corrections and comments
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Authors and funding
4 authors at 4 institutions in 1 country.
Funding
Abstract
backgroundPatients with severe mental illness may be subjected to Community Treatment Orders (CTOs) in order to secure that the patients adhere to treatment. Few studies have investigated the use of CTOs within an Assertive Community Treatment (ACT) setting, and little is known about how the tension between the patients' autonomy and the clinicians' responsibility to act in the patients' best interest are resolved in practice. The aim of this study was to explore the service providers' experiences with CTOs within an ACT setting.
methodsThe study was based on reviews of case files of 15 patients, eight individual qualitative in depth interviews and four focus group interviews with service providers involved in ACT and decisions related to CTOs. A modified grounded theory approach was used to analyze the data.
resultsThe main theme 'responsibility with conflicting priorities' emerged from data analysis (case file reviews, individual interviews and focus group interviews). The balance between coercive approaches and the emphasis on promoting patient autonomy was seen as problematic. The participants saw few alternatives to CTOs as long-term measures to secure ongoing treatment for some of the patients. However, participants perceived the ACT model's comprehensive scope as an opportunity to build rapport with patients and thereby better meet their needs. The team approach, the ACT providers' commitment to establish supportive relationships and the frequent meetings with patients in their home environment were highlighted. The ACT approach gave them insight into patients' everyday lives and, in some cases a greater sense of security when considering whether to take patients off CTOs.
conclusionsMany of the participants viewed CTOs as helpful in securing long-term treatment for patients. CTO decision-making was described as challenging and complex and presented the providers with many dilemmas. The ACT approach was considered as helpful in that it afforded comprehensive, patient-centered support and opportunities to build rapport.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.