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Persuading the persuadable: evaluating compulsory treatment in England using Supervised Discharge Orders.
V Pinfold1, J Bindman, G Thornicroft
1Health Service Research Department, Institute of Psychiatry, Kings College London, UK.
Social Psychiatry and Psychiatric Epidemiology
|August 23, 2001
Summary
Supervised Discharge Orders (SDOs) in England are increasingly used for mental health patients. Most patients comply with SDO conditions, suggesting effective treatment is possible without enforcing medication.
Area of Science:
- Mental Health Law
- Psychiatric Practice
- Healthcare Policy
Background:
- Supervised Discharge Orders (SDOs) were introduced in England and Wales in 1995.
- SDOs mandate patient adherence to conditions upon hospital discharge but lack medication compliance enforcement.
- Initial reception by the psychiatric profession was marked by skepticism.
Purpose of the Study:
- To describe the utilization of SDOs across England.
- To characterize patients subjected to SDOs.
- To evaluate the efficacy of SDOs in ensuring treatment compliance post-discharge.
Main Methods:
- A survey encompassing 170 mental health provider Trusts in England.
- Qualitative analysis of interviews with senior managers from 12 Trusts and Local Authorities.
- Description of a patient cohort under SDOs from 56 randomly selected Trusts.
Main Results:
- In 1999, SDOs were applied to 596 patients (1.2 per 100,000 population), with usage steadily rising since introduction.
- SDOs are not systematically considered for all eligible cases.
- The majority of the 182 patients in the cohort demonstrated compliance, albeit sometimes intermittently, with SDO conditions.
Conclusions:
- For patients adhering to Supervised Discharge Orders, effective treatment can be achieved without mandatory medication compliance.
- The study highlights the potential of SDOs in managing patient treatment adherence.