title: Service-user and carer perspectives on compliance and compulsory treatment in community mental health services.
abstract: This paper reports on a qualitative study analyzing service-user (SU) and carer perspectives on medication compliance and their experience of compulsory treatment. Eleven SUs and eight carers were interviewed. The research is set against the background of changes to mental health legislation in England, in the form of Supervised Community Treatment. This signals a change in community mental health practice and urges a reconsideration of concepts such as compliance, concordance and coercion. These concepts are discussed in the context of legislative changes and in relation to the perspectives of service-SUs and carers. Five themes emerged from qualitative interview data, analysed using an adapted form of grounded theory: loss of credible identity, playing the game, medicalization, therapeutic competence and incompetence and increased control. The findings suggest that SUs are initially reluctant to comply with mental health treatment, but do eventually accept the need for treatment; they also stress the significance of respectful relationships with professionals and the importance of communicative competence.
authors.affiliation: Joint Faculty of Health and Social Care Sciences, Kingston University and St George's University of London, London, UK. i.gault@sgul.kingston.ac.uk
authors.forename: Iris
authors.initials: I
authors.lastname: Gault
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003156:Community Mental Health Services; D023801:Directly Observed Therapy; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D055815:Young Adult