Community Treatment Orders: what do they tell us about the exercise of power over the psychiatric patient?

  • Deborah Martin

Student thesis: Doctoral ThesisPhD


Community Treatment Orders (CTOs) provide a means by which treatment for mental disorder may be imposed upon some psychiatric patients once they are discharged from detention in hospital. They are intended to prevent patients disengaging from treatment, avoiding a deterioration in their condition which may result in harm and readmission to hospital. Although initially intended for a small number of patients who posed most risk, their uptake far exceeded Government expectation, yet research has questioned their effectiveness in achieving their intended aims. This study explores the exercise of professional power over the psychiatric patient by analysing professional decision-making in the use of CTOs to better understand the reasons for their use. To do this, the theory of governmentality was used as a means of analysing professional actions. This analysis adds to the existing body of knowledge by examining the factors influencing professional decision-making. The findings highlight professional justification for CTO use and reveal the balance of care and control over the psychiatric patient.
This study employs qualitative methods to gather data from the two professional groups involved in the CTO decision-making process: responsible clinicians (RCs) and approved mental health professionals (AMHPs). Individual and joint interviews allowed the gathering of rich, contextualised data from 18 participants. The findings show that medical discourse is dominant among RC and AMHP participants. This is evident in participant accounts of mental disorder and its associated behaviours and in professional responses to mental disorder. In addition, some more socially orientated considerations form part of CTO consideration. These social factors are not, however, concerned with the patient, but with interdisciplinary dynamics and resources. These findings indicate that the balance of power rests with professionals, as opposed to patients, and that CTOs are being used to protect professionals, ahead of patients and the public.
Date of Award13 Feb 2019
Original languageEnglish
Awarding Institution
  • University of Bath
SupervisorIan Butler (Supervisor) & Jeremy Dixon (Supervisor)

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