title: "Care or control?": a qualitative study of staff experiences with outpatient commitment orders.
abstract: Outpatient commitment orders are being increasingly used in many countries to ensure follow-up care of people with psychotic disorders after discharge from hospital. Several studies have examined outpatient commitment in relation to use of health care services, but there have been fewer studies of health professionals' experiences with the scheme. The purpose of this study was to examine health professionals' experiences with patients subject to outpatient commitment.
  
  
  
  This was a focus group study using a descriptive and exploratory approach. The study was based on three focus group interviews with a total of 22 participants. Data were analysed using qualitative content analysis.
  
  
  
  The study showed that health professionals had a positive attitude towards outpatient commitment and considered it necessary for patients with psychosis who lacked insight and did not collaborate on treatment. At the same time their attention to patients' lack of insight could lead to a paternalistic approach more than measures to enhance patient autonomy. This challenged their therapeutic relationship with the patient.
  
  
  
  Health professionals found it difficult to combine control with therapeutic care, but gave greater emphasis to patients' need for treatment and continuity of care than to their autonomy. This dilemma indicates a need to discuss whether increased attention to patients' autonomy rather than insight into their illness would improve treatment cooperation and reduce the use of coercion.
authors.affiliation: Institute of Community Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway. bjorn.stensrud@sykehuset-innlandet.no.|Innlandet Hospital Trust, P.O. Box 104, 2381, Brumunddal, Norway. bjorn.stensrud@sykehuset-innlandet.no.
authors.forename: Bjørn
authors.initials: B
authors.lastname: Stensrud
authors.affiliation: Norwegian Research Network On Coercion in Mental Healthcare and Institute of Community Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway.
authors.forename: Georg
authors.initials: G
authors.lastname: Høyer
authors.affiliation: Innlandet Hospital Trust, P.O. Box 104, 2381, Brumunddal, Norway.
authors.forename: Gro
authors.initials: G
authors.lastname: Beston
authors.affiliation: Innlandet Hospital Trust, P.O. Box 104, 2381, Brumunddal, Norway.|Faculty of Public Health, Hedmark University College, Elverum, Norway.
authors.forename: Arild
authors.initials: A
authors.lastname: Granerud
authors.affiliation: Norwegian National Advisory Unit On Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway.|SERAF, Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway.
authors.forename: Anne Signe
authors.initials: AS
authors.lastname: Landheim
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D001291:Attitude of Health Personnel; D001364:Awareness; D003068:Coercion; D003134:Commitment of Persons with Psychiatric Disorders; D003299:Cooperative Behavior; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D009664:Norway; D010351:Patient Discharge; D011618:Psychotic Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*
keywords: Coercion; Insight; Mental health professionals; Outpatient commitment; Psychosis