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Supported decision-making (SDM) may reduce coercive practices like Community Treatment Orders (CTOs) in mental health care. However, system-wide changes are needed to prioritize patient preferences and reduce stigma.

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Area of Science:

  • Mental Health Law and Ethics
  • Psychiatry and Psychology
  • Public Health Policy

Background:

  • Victoria, Australia, has high rates of Community Treatment Orders (CTOs).
  • Supported decision-making (SDM) is emphasized in the Mental Health Act, 2014, to promote recovery-oriented practice.
  • International human rights obligations necessitate alignment with Australian laws and practices.

Purpose of the Study:

  • To investigate barriers and facilitators to SDM for individuals with severe mental health conditions, their families, and practitioners.
  • To explore how SDM can reduce coercion and align practices with human rights.
  • To examine experiences with SDM in the context of CTOs.

Main Methods:

  • Interdisciplinary project in Victoria, Australia.
  • Examined experiences, views, and preferences of mental health consumers (including those on CTOs), family members/carers, and mental health practitioners.
  • Qualitative data collection and analysis to understand perspectives on SDM and CTOs.

Main Results:

  • Findings cautiously suggest SDM may reduce CTO use and coercive practices.
  • SDM can improve experiences of individuals on CTOs through greater respect for their views and preferences.
  • Participants expressed ambivalence towards CTOs, citing medication focus, limited communication, and fears of harm and stigma as concerns.

Conclusions:

  • Implementing SDM requires system-wide transformation and a shift in values and practice.
  • Supporting decision-making for individuals on CTOs necessitates respecting their treatment preferences.
  • Reducing CTO use and coercion involves addressing staff fears, stigma, and prioritizing patient-centered care.