Stuen Hanne Kilen, Rugkåsa Jorun, Landheim Anne, Wynn Rolf
Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brummundal, Norway.
Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway.
BMC Health Serv Res. 2015 Sep 23;15:409. doi: 10.1186/s12913-015-1083-x.
Since 2009, 14 assertive community treatment (ACT) teams have started up in Norway. Over 30 % of the patients treated by the ACT teams were subject to community treatment orders (CTOs) at intake. CTOs are legal mechanisms to secure treatment adherence for patients with severe mental illness. Little is known about patients' views and experiences of CTOs within an ACT context.
The study was based on qualitative in depth interviews with 15 patients that were followed up by ACT teams and that were currently subjected to CTOs. The data were analyzed by using a modified grounded theory approach.
While some participants experienced the CTO as a security net and as an important factor for staying well, others described the CTO as a social control mechanism and as a violation of their autonomy. Although experiencing difficulties and tensions, many participants described the ACT team as a different mental health arena from what they had known before, with another frame of interaction. Despite being legally compelled to receive treatment, many participants talked about how the ACT teams focused on addressing unmet needs, the management of future crises, and finding solutions to daily life problems. Assistance with housing and finances, reduced social isolation, and being able to seek help voluntarily were positive outcomes emphasized by many patients.
The participants had different views of being on a CTO within an ACT setting. While some remained clearly negative to the CTO, others described a gradual transition toward regarding the CTO as an acceptablesolution as they gained experience of ACT. Many of the participants valued the supportive relationship withthe ACT team, and communication with the care providers and the care providers' attitudes could make a significant difference. The study shows that the perception of coercion is context dependent, and that the relationship between care providers and patients is of importance to how patients interpret the providers' behavior and the restrictive interventions.
Although some patients focused on loss of autonomy and being compelled to take medications, other patients emphasised the supportive relationships they had with the ACT teams and that they had received help with housing, finances, and other daily life problems. Thus, being on mandated community treatment could be acceptable in the opinion of several of the patients, provided that they received other services that they found beneficial.
自2009年以来，挪威已成立了14支积极社区治疗（ACT）团队。ACT团队所治疗的患者中，超过30%在入院时就受到社区治疗令（CTO）的约束。CTO是确保重症精神疾病患者坚持治疗的法律机制。在ACT背景下，对于患者对CTO的看法和体验知之甚少。
该研究基于对15名患者的定性深入访谈，这些患者由ACT团队跟进，目前正受到CTO的约束。采用改良的扎根理论方法对数据进行分析。
一些参与者将CTO视为安全保障和保持健康的重要因素，而另一些人则将CTO描述为一种社会控制机制，是对其自主权的侵犯。尽管经历了困难和紧张，但许多参与者将ACT团队描述为与他们以前所知的不同的心理健康领域，有着不同的互动框架。尽管在法律上被强制接受治疗，但许多参与者谈到ACT团队如何专注于满足未得到满足的需求、管理未来危机以及找到日常生活问题的解决方案。许多患者强调了在住房和财务方面得到的帮助、社交孤立感的减轻以及能够自愿寻求帮助等积极成果。
参与者对于在ACT环境下接受CTO有不同的看法。虽然有些人对CTO仍然明显持负面态度，但另一些人表示，随着他们获得ACT的经验，逐渐转向将CTO视为可接受的解决方案。许多参与者重视与ACT团队的支持性关系，与护理提供者的沟通以及护理提供者的态度可能会产生重大影响。该研究表明，对强制的认知取决于具体情境，护理提供者与患者之间的关系对于患者如何解读提供者的行为和限制性干预措施至关重要。
尽管一些患者关注自主权的丧失和被迫服药，但其他患者强调了他们与ACT团队的支持性关系，以及他们在住房、财务和其他日常生活问题上得到了帮助。因此，在一些患者看来，如果他们得到了其他他们认为有益的服务，接受强制社区治疗可能是可以接受的。
