Experiences with outpatient commitment orders from the perspectives of patients, relatives and staff

Background: Compulsory outpatient psychiatric care or outpatient commitment (OC) is intended to ensure treatment of people with severe psychotic disorders after discharge from inpatient care. Although OC has long been used in... [ view full abstract ]

Background: Compulsory outpatient psychiatric care or outpatient commitment (OC) is intended to ensure treatment of people with severe psychotic disorders after discharge from inpatient care. Although OC has long been used in Norway, there is little research-based knowledge of the extent and content of the scheme and a particular lack of knowledge of the experiences of those involved.  

Methods: The studies are based on individual interviews with patients subject to OC (n=16) and their relatives (n=11), and three focus group interviews with a total of 22 health professionals. The analysis of patient data is based on constructivist grounded theory and the analysis of data from relatives and health professionals is based on qualitative content analysis.

Results: The results show that patients found OC to be an obstacle to social integration and prevented them from basing their recovery process on their own experiences. Relatives found that scheme relieved them, but they felt that health professionals did not acknowledge their expertise and experiences. Health professionals experienced a dilemma in attempting to combine therapeutic responsibility with the management of coercion. Recovery from mental illness is largely a question of patients developing everyday coping skills. Health professionals should therefore increasingly consider whether OC is equally useful for all patients with psychosis and whether poor cooperation on treatment may partly be due to patients having other priorities for their lives.

Conclusion: Since the use of OC in Norway is largely justified by the patient’s treatment needs, the scheme must facilitate patients’ involvement in their own recovery, and use resources in the patient’s environment to enhance treatment. The results show that the interaction between patients, relatives and OC decision makers should be improved compared to how the scheme is practiced today.