NHS Professionals sponsors the Florence Nightingale Foundations’ research scholarships, and is thrilled to introduce four new scholars.
Lee Marklew, a case manager in the Assertive Outreach Team, St Marys Hospital,
Leeds & York Partnerships NHS Foundation Trust has been awarded his scholarship to undertake the fourth year of his PhD. The title of his study is: “Making sense of Community Treatment Orders: the service-user experience”.
How did you find out about the Florence Nightingale research scholarships?
A previous scholar suggested I apply, adding that I would have to attend an interview in London but that ‘they are really nice people’ and it would be a great experience. This proved to be true; everybody I have met at the Foundation has been personable, professional and encouraging.
What is a Community Treatment Order?
A Community Treatment Order is a legal measure that allows mental health teams to impose compulsory supervision on a patient after they have been discharged from an involuntary stay in hospital.
Why did you choose to conduct your research on this topic?
Community Treatment Orders (CTOs) for mental health service-users have been controversial since their introduction in 2008, with over 14,000 used to date with their proportionate use increasing each year. CTOs are clinically and ethically contentious as failure to comply with treatment in the community may mean compulsory return to hospital and enforced treatment. They are widely used in my team and I have direct experience of their implementation with variable, unpredictable and sometimes surprising responses. Despite being used in many countries for many years the majority of published research has resulted in conflicting evidence, ambivalence and confusion. There have been no in-depth qualitative studies interpreting and analysing the impact of CTOs on service-users. I recognised a need to further investigate how service-users experience and make sense of CTOs.
What are the aims of the research?
To explore the meaning, understanding and purpose of CTOs for service-users and investigate the felt impact on their daily lives. To also examine the service-user story, account, description and current experience of mental health services. Then to generate analytic outputs that may help service providers and users achieve more effective CTO support.
What do you hope to achieve?
For the study to generate a detailed thematic structure that demonstrates and explains how CTOs impact on the life of service-users, and how they make sense of this new approach to treatment in the community. Then to use this thematic structure to develop a conceptual model that can help service-users optimise their experience, and act as a guide for clinicians in developing effective CTO, and post-CTO, interventions within the changing socio-political environment.
What methodologies will you use to achieve your objectives?
Data will be collected using semi-structured interviews with diaries and some self-directed photo-journals employed to help elicit interview responses. The data will be analysed using Interpretive Phenomenological Analysis (IPA). IPA can be used as an experiential qualitative approach where, typically, interpretation will move through progressive levels to a deeper and more enlightening analysis.
Why did you choose to use IPA to conduct your research?
IPA offers the opportunity to understand and learn from the in-depth insights of the experts – the service-user themselves. The participant’s lived experience is interpreted by subjective and reflective processes developed around the central account of the participant’s responses.
We will be following Lee’s research process over the next year and look forward to seeing his results.
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