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

International Journal for Equity in Health

Magnus Mfoafo-M¿Carthy¹ 

[1] Lyle S. Hallman Faculty of Social Work, Wilfrid Laurier University, 120 Duke Street West, Kitchener N2H 3W8, ON, Canada

关键词: Mental health treatment;    Racism;    Ethnic minority;    Mental illness;    Mental health;    Community Treatment Orders (CTOs);   

Others  :  1146428
DOI  :  10.1186/s12939-014-0069-3

 received in 2014-01-02, accepted in 2014-07-25,  发布年份 2014

【 摘 要 】

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.

【 授权许可】

   
2014 Mfoafo-M'Carthy; licensee BioMed Central Ltd.

【 参考文献 】

• [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.
• [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.
• [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.
• [4]Wamala S, Bostrom G, Nyqvist K: Perceived discrimination and psychological distress in Sweden. British J Psychiatr 2007, 190:75-76.
• [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.
• [6]Williams CC: Ethical considerations in mental health research with racial and ethnic minority communities. Community Ment Health J 2005, 41(5):509-519.
• [7]McKenzie K, Bhui K: Institutional racism in mental health care. Br Med J 2007, 334(7595):649-650.
• [8]Tinsley-Jones H: Racism: calling a spade a spade. Psychother 2003, 40(3):179-186.
• [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]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. University of Toronto, Toronto, Canada; 2010. Unpublished doctoral dissertation
• [12]Bhugra D, Ayonrinde O: Racism, Racial life events and Mental Health. Advances in Psychiatric Treatment 2001, 7:343-349.
• [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.
• [15]Essed P: Everyday racism: Reports from women of two cultures. Hunter House Inc, Claremont, CA; 1990.
• [16]Williams DR, Collins C: US socio-economic and racial differences in health. patterns and explanations. Annu Rev Sociol 1995, 21:349-386.
• [17]Mullaly B: Challenging Oppression and Confronting Privilege. Oxford University Press, Don Mills, Ontario; 2010.
• [18]Thompson-Miller R, Feagin JR: Continuing injuries of racism: counseling in a racist context. Counsel Psychol 2007, 35:106-115. doi:10.1177/0011000006294664
• [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.
• [21]Mental health: Culture, race, ethnicity ¿ A supplement to mental health: A report of the surgeon-general. US Department of Health Services Administration, Centre for Mental Health Services, National Institutes of Health, National Institute of Mental Health, Rockvile, MD; 2001.
• [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.
• [24]Shavers VL, Shavers BS: Racism and health inequity among Americans. J Natl Med Assoc 2006, 98(3):386-396.
• [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.
• [26]Torrey FE, Zdanowicz M: Outpatient commitment: What, why, and for whom? Psychiatr Serv 2001, 52(3):337-341.
• [27][http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_90m07_e.htm] webcite Ontario: The Mental Health Act, Revised Statutes of Ontario, Chapter M7, amended by Mental Health Legislation Reform. 1990, .
• [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.
• [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.
• [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.
• [31]Lamb HR: Combating stigma by providing treatment. Psychiatr Serv 1999, 50(6):729.
• [32][http://www.qsos.cc/qspc/nfc/news.html] webcite Mallan C, Boyle T: Brian¿s Law: Ottawa sportscaster¿s murder sparks new bill aimed at mentally ill. The Toronto Star; 2000. .
• [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.
• [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.
• [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]Weitz D: Psychiatric fascism. 2000.
• [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.
• [38][http:/ / www.health.gov.on.ca/ en/ common/ ministry/ publications/ reports/ dreezer/ dreezer.pdf] webcite Dreezer S, Bay M, Hoff D: Report on the legislated review of community treatment orders, required under Section 33.9 of the Ontario Mental Health Act, 2005. Retrieved June 8, 2013 from .
• [39]Creswell JW: Qualitative Inquiry and Research Design, Choosing Among Five Approaches. Sage, Thousand Oaks, California; 2013.
• [40]Moustakas C: Phenomenological research methods. Sage, Thousand Oaks, CA; 1994.
• [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.
• [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.
• [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.
• [44]Bhabha HK: The location of Culture. Routledge, London; 2004.
• [45]Linhorst DM: Empowering People with Severe Mental Illness. A Practical Guide. Oxford University Press, New York; 2006.
• [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.
• [47]Hiday VA, Scheid-Cook TL: Outpatient commitment for ¿revolving door¿ patients: compliance and treatment. J Nerv Ment Dis 1991, 1991(179):83-88.