Julia Stroud

A psychosocial analysis of child homicide

Child homicide has been a key influence on childcare policy and practice over the last three decades, with a particular focus on the assessment, management and monitoring of situations where children are at risk and on associated inter-agency working. A psychosocial analysis of the pre-offence experiences of 68 adults (mostly parents or carers) who killed or attempted to kill a child identified complex, intricate and heterogeneous processes in respect of their interpersonal relationships, stress and mental health and the relationship of these factors to the offence. These findings indicate that the current policy and practice focus upon procedures and performance in safeguarding children may not address successfully the complex needs of those adults who may pose a risk to children. It is suggested that appropriate therapeutic services should be more readily available.

Community treatment orders: learning from experiences of service users, practitioners and nearest relatives.

Abstract Background: The effectiveness of Community Treatment Orders (CTOs) has been examined previously. However, few studies have explored the significance of service user and practitioner understandings. Aims: The study explored the experiences of service users, practitioners and nearest relatives, to identify key factors and good practice in relation to CTOs. Method: A study of CTOs in a mental health NHS Trust in Southern England, including 72 semi-structured interviews, analysed thematically. Results: CTOs were perceived as helpful in certain circumstances for the “right” service user. Factors influencing effectiveness included recognition of the containing elements of the CTO, a respect for its legal authority and an acceptance of conditions. Conclusions: The perceptions of service users have an important role in determining the value and potential effectiveness of CTOs. A consideration of these issues should be integral to the process of assessing whether a CTO is appropriate in individual cases.

Community treatment orders: exploring the paradox of personalisation under compulsion

The introduction of supervised community treatment, delivered through community treatment orders (CTOs) in England and Wales, contrasts with the policy of personalisation, which aims to provide service users autonomy and choice over services. This article draws upon findings from a primarily qualitative study which included 72 semi-structured interviews (conducted between January and December 2012) with practitioners, service users and nearest relatives situated within a particular NHS Trust. The article also refers to a follow-on study in which 30 Approved Mental Health Practitioners were interviewed. The studies aimed to develop a better understanding of how compulsory powers are being used in the community, within a policy context that emphasises personalisation and person-centred care in service delivery. Findings from the interview data (which were analysed thematically) suggest that service users were often inadequately informed about the CTO and their legal rights. Furthermore, they tended to be offered little, or no, opportunity to make choices and have involvement in the making of the CTO and setting of conditions. Retrospectively, however, restrictions were often felt beneficial to recovery, and service users reported greater involvement in decisions at review stage. Areas of good practice are identified through which person-centred care can be better incorporated into the making of CTOs.