1. Department of Social Policy and Social Work,
What counts as ‘counter-conduct’? A governmental analysis of resistance in the face of compulsory community care
Hannah Jobling,
Department of Social Policy and Social Work,
University of York

2. Compulsory community care
70+ jurisdictions in various forms
England and Wales from 2008:
Mental Health Act (2007)
Community Treatment Orders (CTOs)
Conditions
Recall mechanism
Perpetual renewal

3. CTOs: Policy and practice
Policy drivers:
Foundational purpose to ensure compliance
‘Revolving door’
Stability and recovery
Risk management
Practice:
Broad criteria for use and clinical discretion
The use of CTOs has increased year by year
2013/14: 5365 people subject to CTOs > 6% >32%
(Health and Social Care Information Centre, 2014)

4. CTOs: Ethical dilemmas
Concordance vs. control
Least restrictive v.s perpetual compulsion
Identity and sense of self
What happens to people when
they are under CTOs?
How do they respond to
community compulsion?

5. Governmentality: Ends and means
Power/knowledge
Disciplinary power
Reflexive power
Analysis of the ‘how’ of governing
Visibility and discourse
Knowledge and technologies
Identity

6. The ‘conduct of conduct’
Practices of the self
how “individuals recognise themselves as particular kinds of persons and…work upon and transform themselves in certain ways and towards particular goals” (Hodges, 2004, 457).
Conduct and counter-conduct
“The will not to be governed thusly, like that, by these people, at that price” (Foucault, 2007, 75).

7. The Study
To establish how the implementation of CTO policy is being realised and with what implications for the experiences of service users and practitioners.
Case study design: Two Trusts > One AOT in each Trust > 18 CTO cases across the field sites
Fieldwork took place over 8 months and tracked the progress of the 18 cases:
Interviews with 18 service users and 36 practitioners
Observation of key meetings, daily practice and informal interactions
Content analysis of case files

8. CTOs and ‘practices of the self’
Three case studies
Acceptance and reverse coercion
Resistance and perverse consequences
Subversion and coping strategies
Highlight ways in which conduct and counter-conduct manifest within the CTO

9. Acceptance - Nick
Submersion in a ‘risk’ identity: I don’t want to go back to square one when I was walking the streets and I was out of control. I’ll be honest, I don’t know how I’m even still here. I’m surprised I haven’t been locked up
The imposition of external control: It’s this-, like a fire guard. You have a fire burning; you need to be safe and you need that guard around it. That’s what a CTO is.
Reverse coercion and discharge: I’d like to stay on it for the rest of my life, that’s what I keep telling them.

10. Resistance - Sheila
Stigma and fear: I’d be much freer without it. I wouldn’t be looking over my shoulder all the time. I just want to get on with my life like a normal person would get on with their life.
Reinforcement of barriers and ‘surface’ work: ‘she’s not on my side’
Focus on rights rather than relations – using the system of legal oversight
Perverse consequences:
Avoidance, repeat recalls and increased intervention
To discharge or not to discharge? I’m altogether a lot more agreeable about seeing people, it's changed the climate of it you know.

11. Subversion - Simon
‘Playing the CTO game’ and triggering recalls: it was a free way of getting into hospital.
Seeking ‘asylum’ within residualised services: He gains that admission, because that's what was always done…he's always had his flat and when he's had enough of life, and dealing with living alone, he's gone into respite, and he chose when to do that and that's how he was managed previously. We haven't got the respite facility now, so the only way he can get respite is by becoming non-compliant and getting into hospital that way
Maintaining control of coping strategies? What he would like is to say when he thinks he needs an admission, I think he resents the fact he has to go via me and the team

12. Summary
Situating the ‘target’ individual – their history, hopes, self-conception – is necessary for an analysis of policy in practice and its implications
Thin ‘behavioural’ assumptions – ‘carrots, sticks and sermons’ - do not account for such reflexive work.
Conduct and counter-conduct in relation to policy ‘ends and means’ cannot be analysed separately – continuity and movement between the two.