Welcome to the Oxford Psychology Podcast series brought to you today by Daniel Morcombe, an advanced training in psychiatry at Oxford Deanery.
I'm here today with Francis Scott, Thurgood's Tesa DCO student at the University Department of Psychiatry,
and he's working in the social psychiatry group. So, Francis, thank you very much for joining us here today.
Maybe we can start with what you do in social psychiatry group.
OK, thanks. And so I joined the social psychiatry group in early 2012 and initially assisted as a research assistant,
primarily on the Octet trial, which is the trial of community treatment orders, and then later applied to start to develop a Ph.D.
And we've been doing that for the last 18 months. And that works on the.
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.
So what's your background? OK, so.
Well, I worked in Italy for four years before I started my undergraduate degree.
And other than a brief stint as a rock climbing instructor, I worked early in health care, Italy, working with children with learning disabilities,
then with young adults with mental health problems and some substance abuse history, and then later on with older adults with disabilities.
And then I started my undergraduate degree in psychology and got very into the research side of things, but very excited about that.
And I then went on to work as a research assistant and also did a master's in psychiatric research.
And my main research interests have have really been the psychology and psychiatry.
And and more and more recently, I've become interested in broader public health challenges,
things like obesity and looking at things like the health benefits of tackling climate change, for example.
Brilliant. Thank you. Thank you. So let's move on to looking at what you're doing now.
You said you're doing a film. You said you're working alongside this randomised controlled trial into community treatment orders.
Maybe you can just give us a brief outline of what what the details of what you're doing.
OK, so what I'm doing is this.
A community treatment order trial was designed to test the effectiveness of so-called community treatment orders,
which is supervised community treatment and restriction under the Mental Health Act,
where people are patients with severe mental illnesses reside in the community.
And I'm following up the subsample from the study, about 120 patients and four years after the end of the trial.
And I'm looking at whether there's an association between the amount of time
that these patients have spent and the what we call compulsion or coercion,
and that is the hospital compulsions,
involuntary detention in hospital or community compulsion in the form of community treatment, of supervised community treatment.
And I want to explore whether there's an association between this kind of compulsion and social outcomes and such all kinds of things,
like whether people have work, whether they want to live independently, meets socially with friends, have meaningful activities and so on.
Well, presuming that they're under a community treatment order,
probably the more severe end of the mental illness spectrum with with maybe multiple co morbidity.
So it's quite hard to get that well and social outcomes for them to be maybe realistic,
because getting a lot of these people back into work might be quite a hard challenge.
Have you found any any results so far about about social outcomes of these patients?
So I think the data that I've looked at so far haven't produced anything conclusive.
I think it's difficult to say right now that it is true that these patients with chronic psychotic illnesses,
primarily schizophrenia, do have poor clinical and social outcomes.
Such outcomes in the long term are not good for this patient group.
They're very unlikely to get back into work and into competitive employment.
Many of them live independently and many of them have very limited social networks.
And so I think overall,
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
to their social situation when they were recruited through the trial hasn't really changed very much over the.
Before we follow up, well, that's an interesting result about community treatment orders not impacting on social outcomes,
what kind of things could mental health services do to improve social outcomes?
Is there any evidence around at the moment that demonstrates improved social outcomes for mental health services?
I think broadly the concept of social inclusion might be helpful and social inclusion or inclusion as a way of thinking about disadvantaged areas.
When we think about people with severe mental illness is something that's very striking,
is how disadvantaged these people are in all kinds of different ways.
And so, for example, getting people back involved in employment and it gives them something constructive to do because in the sense of purpose,
it increases their social networks.
And so there's all kinds of advantages, I think, in terms of what we know from the literature and ideas, for example,
which tries to get people with severe mental illnesses back into employment, has been actually shown to be very effective.
And individual placements support has been has been posted, doesn't it?
And the whole recovery agenda is the star recovery plan has been integrated quite well with mainstream mental health services,
such as moving towards a recovery agenda that you think will help mental health services improve social outcomes with patients and their services.
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.
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,
but what impact do you think this is going to have on services? Well,
I think I'm trying to better understand the relationship between the use of compulsion in psychiatry and social outcomes is very important because
compulsion is extremely widely used in virtually every country in the world in some kind of form and either in hospital or community settings.
So I think we really need a better understanding about how this kind of treatment is affecting patients,
not just clinically, but also in terms of their social situation.
So we'd actually do very serious things by talking about voluntary admitting patients.
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.
And is that is there anything about this this compulsion which you think could potentially lead to improve social outcomes?
Do you think that there's something more that we could be doing as mental health services?
Well, I think from the literature in the literature is quite mixed views on that.
This is on the one hand, the path.
The truth is the more sort of traditional standard view that the use of compulsion is, of course, in the patient's best interests,
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.
And that is actually not that much evidence to support that view.
And on the other hand, you've got people, for example, from the recovery movement who are arguing that,
in fact, the use of compulsion is creating negative experiences for these patients.
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.
So it seems like you're actually saying that compulsion may be something that we need to move
on from and the mental health services or maybe something we need to avoid at all costs.
And I think it's probably a necessary evil to some extent.
I think it's very unlikely that the way that this situation where we can completely remove compulsion from mental health treatment.
But I think we have to think very carefully about when it's appropriate and what the likely benefits are.
So, for example, if we go back to social research outcomes,
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.
We really don't know how to fix social outcomes. Yes.
And that's that's a problem because we're using it and based on the assumption that it will lead to benefit.
But we don't actually know that it does. And that's, of course, problematic.
And so I think we need to because it's such an invasive social legal intervention that really limits an individual's freedoms.
We need to think very carefully about how we use it when we use it.
While Francis has be very interesting to talk to you today.
Thank you very much for your time. Thank you for tuning in. And I hope you listen to more of our podcast series.
Thank you. Goodbye.