A 'bittersweet pill to swallow': learning from mental health service users' responses to compulsory community care in England

Health Soc Care Community. 2002 Sep;10(5):361-9. doi: 10.1046/j.1365-2524.2002.00375.x.


Two forms of compulsory mental healthcare and supervision in the community are provided within the Mental Health Act 1983: Supervised Discharge Orders (SDOs) and guardianship. At a time when the Government are proposing to extend powers of supervision over people with severe mental illness in the community, it is appropriate that service users' experiences of existing legislation are examined and reported. Despite a range of literature that presents mental health service users' views and experiences, it remains unclear how service users respond to compulsory community mental healthcare in England. The present paper presents the findings of a qualitative investigation into service users' perceptions and experiences of living with SDOs. In the interviews, service users communicated their understanding of why mental health professionals placed them on the order and how their lives have been affected. Individual service users are capable of seemingly contradictory responses, simultaneously accepting and resisting the orders. This paper presents a typology of the range of responses. These responses are fatalism and resignation, dependency, ownership, bargaining, cooperation, resistance, and rejection. The study provides a model with which we can begin to understand how service users respond to compulsory community care where their options are legally constrained.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Coercion
  • Community Mental Health Services / legislation & jurisprudence*
  • Community Mental Health Services / organization & administration
  • Deinstitutionalization
  • England
  • Female
  • Humans
  • Legal Guardians / legislation & jurisprudence*
  • Male
  • Mentally Ill Persons / psychology*
  • Middle Aged
  • Outcome Assessment, Health Care
  • Patient Compliance / psychology*
  • Patient Satisfaction*
  • Qualitative Research
  • Social Support