Examining the use of metaphors to understand the experience of community treatment orders for patients and mental health workers

Background: Community Treatment Orders (CTOs) are complex because of the ethical tensions between promoting the patient's good through an inherently coercive process. There is limited research that examines how patients and workers make sense of the CTO experience. Methods: In-depth interviews with 8 patients on CTOs and 10 community mental health workers in South Australia explore how they constructed their experiences of CTOs, with Critical Discourse Analysis used to analyse the data. Results: Patients’ and workers’ CTO experiences were multidimensional, involving both positive and negative constructions, expressed in the form of metaphors i: the positive metaphor of CTOs as a safety net, and the negative metaphors of power 125 and control (CTO as control, wake-up, punishment, surveillance and tranquiliser). The language used to construct these metaphors was quite different, with patients overwhelmingly experiencing and perceiving CTOs as coercive, whereas workers tended to perceive them as necessary, beneficial and supportive, despite their coerciveness. Conclusions: By acknowledging the role of metaphors in patients' lives, workers could enhance opportunities to engage them in more meaningful dialogue about their personal experiences as an alternative to practice predominantly focused on risk. This could enhance workers' reflection on their work and promote recovery-based practice.