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Risk versus recovery: Care planning with individuals on community treatment orders

Research output: Contribution to journalArticlepeer-review

Suzanne Dawson, Eimear Muir-Cochrane, Alan Simpson, Sharon Lawn

Original languageEnglish
Pages (from-to)1248-1262
Number of pages15
JournalInternational Journal Of Mental Health Nursing
Issue number5
Accepted/In press2021
PublishedOct 2021

Bibliographical note

Funding Information: We wish to acknowledge those consumers, carers, and clinicians from?Central Adelaide Local Health Network, who generously participated in this study. Publisher Copyright: © 2021 John Wiley & Sons Australia, Ltd Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

King's Authors


Community treatment orders (CTOs) require individuals with a mental illness to accept treatment from mental health services. CTO legislation in South Australia states that treatment and care should be recovery-focused, although justification for use is predominantly risk-based, and care often coercive. Although CTOs are contested, individuals, families, and clinicians frequently engage in care planning within this context. This paper examines how the concepts of risk and risk management impact care planning from the perspectives of individuals on CTOs, their families, and clinicians. Ethnographic methods of observation and interview provided a detailed account of the perspectives of each group over an 18-month period from two community mental health teams in South Australia. Findings show that care planning occurred within a culture of practice dominated by risk. Risk, however, was understood differently by each participant group, with the dominant narrative informed by biogenetic understandings of mental illness. This dominance impacted on the positioning of participant groups in care planning, focus of care contacts, and care options available. To improve care experiences and outcomes for individuals on CTOs, narrow conceptualizations of risk and recovery need to broaden to include an understanding of personal and social adversities individuals face. A broader understanding should reposition participants in the care planning context and rebalance care discussions, from a focus on clinical recovery to recovering citizenship.

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