Exploring Community Treatment Orders: An Institutional Ethnographic Study

  • Author / Creator
    Snow, Nicole
  • Community Treatment Orders (CTOs) involve mandated community treatment for individuals with severe, persistent mental disorders. The use of CTO legislation in Newfoundland and Labrador (NL), Canada is explored in this study through institutional ethnography (IE). This method is used by researchers seeking to elucidate everyday life experiences that occur within an institution. According to IE, the everyday work of individuals is coordinated and organized by social structures and discourses known as ruling relations that are inherent within an institution. These ruling relations exist often without our overt knowledge or awareness. One of the main findings in this study is that CTOs are socially organized to focus on legal issues of public safety and accountability. Worries about the possible risks to the public of severe, persistent mental illness supersede the therapeutic implications of the CTO. While health professionals’ activation of the CTO proceeds as though it is focused on treatment and recovery, the therapeutic interests are subordinate to the politico-legal interests of government. Informants in this study included family members, nurses and other healthcare team staff, managers, bureaucrats, and legal experts who had experience with CTOs. Data were collected through interviews and document review and examined for evidence of the social web of practices (ruling relations). The actual process of using the CTO legislation was mapped, highlighting the many points at which decisions were being made based on varying interpretations of the legislation. A number of disjunctures, or moments of incongruousness, were found. What the informants described as actually happening with the use of CTO legislation was sometimes in conflict with what they expected to happen, or with what the legislation identified as “suppose to happen”. Nurses’ professional ideology was also challenged in that nurses’ “therapeutic” actions often resulted in practices organized by the legislation that were at odds with the interests of patients and their families. The results of this study offer important insights about the use of CTOs in NL and should be of considerable interest to nurses and other health professionals, advocacy groups, families, and individuals with mental health concerns. It is hoped that increasing awareness to these social structures and disjunctures will foster a greater understanding of the challenges facing mental health nursing practice.

  • Subjects / Keywords
  • Graduation date
    Fall 2015
  • Type of Item
  • Degree
    Doctor of Philosophy
  • DOI
  • License
    This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.