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Welcome to the Oxford Psychology Podcast series brought to you today by Daniel Morcombe, an advanced training in psychiatry at Oxford Deanery.

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I'm here today with Francis Scott, Thurgood's Tesa DCO student at the University Department of Psychiatry,

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and he's working in the social psychiatry group. So, Francis, thank you very much for joining us here today.

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Maybe we can start with what you do in social psychiatry group.

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OK, thanks. And so I joined the social psychiatry group in early 2012 and initially assisted as a research assistant,

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primarily on the Octet trial, which is the trial of community treatment orders, and then later applied to start to develop a Ph.D.

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And we've been doing that for the last 18 months. And that works on the.

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So you started your day, but maybe it'd be helpful just to go back a bit and just look at what you've what you've done to get yourself.

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So what's your background? OK, so.

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Well, I worked in Italy for four years before I started my undergraduate degree.

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And other than a brief stint as a rock climbing instructor, I worked early in health care, Italy, working with children with learning disabilities,

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then with young adults with mental health problems and some substance abuse history, and then later on with older adults with disabilities.

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And then I started my undergraduate degree in psychology and got very into the research side of things, but very excited about that.

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And I then went on to work as a research assistant and also did a master's in psychiatric research.

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And my main research interests have have really been the psychology and psychiatry.

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And and more and more recently, I've become interested in broader public health challenges,

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things like obesity and looking at things like the health benefits of tackling climate change, for example.

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Brilliant. Thank you. Thank you. So let's move on to looking at what you're doing now.

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You said you're doing a film. You said you're working alongside this randomised controlled trial into community treatment orders.

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Maybe you can just give us a brief outline of what what the details of what you're doing.

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OK, so what I'm doing is this.

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A community treatment order trial was designed to test the effectiveness of so-called community treatment orders,

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which is supervised community treatment and restriction under the Mental Health Act,

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where people are patients with severe mental illnesses reside in the community.

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And I'm following up the subsample from the study, about 120 patients and four years after the end of the trial.

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And I'm looking at whether there's an association between the amount of time

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that these patients have spent and the what we call compulsion or coercion,

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and that is the hospital compulsions,

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involuntary detention in hospital or community compulsion in the form of community treatment, of supervised community treatment.

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And I want to explore whether there's an association between this kind of compulsion and social outcomes and such all kinds of things,

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like whether people have work, whether they want to live independently, meets socially with friends, have meaningful activities and so on.

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Well, presuming that they're under a community treatment order,

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probably the more severe end of the mental illness spectrum with with maybe multiple co morbidity.

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So it's quite hard to get that well and social outcomes for them to be maybe realistic,

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because getting a lot of these people back into work might be quite a hard challenge.

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Have you found any any results so far about about social outcomes of these patients?

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So I think the data that I've looked at so far haven't produced anything conclusive.

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I think it's difficult to say right now that it is true that these patients with chronic psychotic illnesses,

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primarily schizophrenia, do have poor clinical and social outcomes.

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Such outcomes in the long term are not good for this patient group.

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They're very unlikely to get back into work and into competitive employment.

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Many of them live independently and many of them have very limited social networks.

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And so I think overall,

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what I what I've seen so far is that there isn't actually that much change over the course of the of the four years

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to their social situation when they were recruited through the trial hasn't really changed very much over the.

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Before we follow up, well, that's an interesting result about community treatment orders not impacting on social outcomes,

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what kind of things could mental health services do to improve social outcomes?

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Is there any evidence around at the moment that demonstrates improved social outcomes for mental health services?

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I think broadly the concept of social inclusion might be helpful and social inclusion or inclusion as a way of thinking about disadvantaged areas.

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When we think about people with severe mental illness is something that's very striking,

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is how disadvantaged these people are in all kinds of different ways.

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And so, for example, getting people back involved in employment and it gives them something constructive to do because in the sense of purpose,

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it increases their social networks.

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And so there's all kinds of advantages, I think, in terms of what we know from the literature and ideas, for example,

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which tries to get people with severe mental illnesses back into employment, has been actually shown to be very effective.

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And individual placements support has been has been posted, doesn't it?

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And the whole recovery agenda is the star recovery plan has been integrated quite well with mainstream mental health services,

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such as moving towards a recovery agenda that you think will help mental health services improve social outcomes with patients and their services.

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Is that way that we are talking about? Yeah, I think broadly that's that the the the recovery the recovery model speaks quite strongly to that.

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OK, let's go back to defo what you've told us about maybe some of the broad potential outcomes of your of your data set,

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but what impact do you think this is going to have on services? Well,

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I think I'm trying to better understand the relationship between the use of compulsion in psychiatry and social outcomes is very important because

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compulsion is extremely widely used in virtually every country in the world in some kind of form and either in hospital or community settings.

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So I think we really need a better understanding about how this kind of treatment is affecting patients,

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not just clinically, but also in terms of their social situation.

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So we'd actually do very serious things by talking about voluntary admitting patients.

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And I guess what you're saying is that part of our duty is mental health services, is to restore the social capital of these patients.

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And is that is there anything about this this compulsion which you think could potentially lead to improve social outcomes?

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Do you think that there's something more that we could be doing as mental health services?

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Well, I think from the literature in the literature is quite mixed views on that.

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This is on the one hand, the path.

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The truth is the more sort of traditional standard view that the use of compulsion is, of course, in the patient's best interests,

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that detaining them will lead to some kind of social, clinical and social benefit for the patients, even if they don't recognise that at the time.

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And that is actually not that much evidence to support that view.

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And on the other hand, you've got people, for example, from the recovery movement who are arguing that,

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in fact, the use of compulsion is creating negative experiences for these patients.

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And actually, in the long run, it's going to push them away from services and and by increasing things like stigma and and yeah.

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So it seems like you're actually saying that compulsion may be something that we need to move

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on from and the mental health services or maybe something we need to avoid at all costs.

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And I think it's probably a necessary evil to some extent.

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I think it's very unlikely that the way that this situation where we can completely remove compulsion from mental health treatment.

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But I think we have to think very carefully about when it's appropriate and what the likely benefits are.

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So, for example, if we go back to social research outcomes,

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we're using social we're using compulsion because we think it leads to some clinical benefits and there's some evidence to support that.

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We really don't know how to fix social outcomes. Yes.

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And that's that's a problem because we're using it and based on the assumption that it will lead to benefit.

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But we don't actually know that it does. And that's, of course, problematic.

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And so I think we need to because it's such an invasive social legal intervention that really limits an individual's freedoms.

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We need to think very carefully about how we use it when we use it.

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While Francis has be very interesting to talk to you today.

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Thank you very much for your time. Thank you for tuning in. And I hope you listen to more of our podcast series.

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Thank you. Goodbye.