The paradox of care and control: experiences of community based compulsory treatment orders in Scotland

Macgregor, Aisha (2019) The paradox of care and control: experiences of community based compulsory treatment orders in Scotland. PhD thesis, University of Glasgow.

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The use of community based compulsory treatment orders for individuals experiencing mental distress is contentious. This is because they are fraught with tensions between care and control. They restrict liberty by mandating compliance with a range of conditions, including medication administration, attending specified services, and allowing professionals into the home space. Despite this, they were introduced in Scotland as part of a wider modernisation agenda, which has earned Scotland a worldwide reputation for leading the way in progressive mental health legislation. The unique Scottish approach is underpinned by rights and principles, which are designed to strengthen voice and choice and benefit ‘revolving door’ patients through access to treatment, and has been framed as a less restrictive option than hospitalisation.

This thesis draws upon qualitative, semi-structured interviews with individuals, their relatives, and mental health advocates to explore whether experiences reflect the rights based intentions of the legislation. It specifically focuses on the named person provision, experiences of care and treatment, control and surveillance, and the mental health tribunal. A relational approach was adopted to examine how CCTOs are negotiated within the context of inter-personal and professional relationships. Furthermore, it uses the ethics of care as a normative model to assess the quality of care being provided, specifically drawing upon Tronto’s (1993, 2013) integrity of care framework to assess this. This thesis contends that the rights based intentions of the legislation are not being realised in practice and that paradoxically, a lack of control, hierarchies of power, and distrust overwhelmingly define experiences of compulsion. It argues that rights based frameworks can only go so far to benefit individuals and that an ethics of care is required to improve practice.

Item Type: Thesis (PhD)
Qualification Level: Doctoral
Keywords: mental health legislation, community based compulsory treatment orders, ethics of care, human rights.
Subjects: H Social Sciences > HM Sociology
Colleges/Schools: College of Social Sciences > School of Social and Political Sciences > Sociology Anthropology and Applied Social Sciences
Supervisor's Name: Watson, Prof. Nicholas and Burns, Dr. Nicola
Date of Award: 2019
Embargo Date: 1 October 2025
Depositing User: Ms Aisha Macgregor
Unique ID: glathesis:2019-75119
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 29 Oct 2019 09:16
Last Modified: 24 Oct 2022 07:31
Thesis DOI: 10.5525/gla.thesis.75119

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