Outcome studies in mental hospitals: a review .

Ten Studies into Psychopathic Personality.

The therapeutic community.

Purpose




The purpose of this paper is to provide an overview of the application of therapeutic community (TC) method in non-TC environments.




Design/methodology/approach




Milieu treatment is defined and differentiated from TC “proper”. Literature is reviewed covering attempts to use TC methods in inpatient wards, across hospitals, and more recently in the criminal justice system and more widely through the enabling environments initiative.




Findings




It is unclear whether TC milieu treatments proved helpful in acute ward environments in their heyday in the 1950s, 1960s and 1970s, in particular those involving people suffering from acute psychosis, and the changing landscape of psychiatric provision may make further investigation difficult. The reasons for this, and for the difficulties reaching a firm conclusion, are outlined. In contrast, TC milieu interventions appear to be demonstrating usefulness more recently in less mixed populations without the implementation of full TC “proper”.




Research limitations/implications




Much of the research is old and the methodology poor, which limits the conclusions that can be drawn.




Practical implications




Recent innovations pick up in a more accessible way principles of therapeutic communities that can inform and improve care in a variety of contexts. They are sufficiently well defined to lend themselves to research, which should now be a priority.




Originality/value




After a gap in developments in the field, recent innovations are reintroducing elements of TC functioning to new contexts including criminal justice settings, inpatient wards, homeless shelters and city communities.

Milieu approaches and other adaptations of therapeutic community method: past and future

During the last two decades the word 'milieu' has crept into the psychiatric lexicon. The genesis of this paper owes something to the fact that its meaning is still not entirely clear. It denotes a therapeutic philosophy, a genus of treatment techniques and a type of clinical design. In common psychiatric usage there are now such familiar terms as 'milieu therapy', 'milieu unit' and 'therapeutic milieu'. For practical purposes it is synonomous with 'therapeutic community'. Milieu therapy is one product of forces that have been evident in psychiatry since World War II. At about this time society began to demand more scrutiny of the vehicles and methods of care. As mental hospitals and therapeutic doctrines came within the purview of an interested public the failings of psychiatric treatment became apparent. Theoretical positions began to drift away from an earlier emphasis on individual disease models and toward ideas about social interaction and group phenomena. Clinical practices engendered by these notions acquired a momentum not wholly explained by documented advances in the behavioural sciences. The events surrounding such change have been described as the 'third revolution' in psychiatry (26). There is an intact lineage between this and the encounter ideology with which today's milieu therapy has an obvious kinship. The effects wrought were influenced by the shape of the institutions in which they took place. A process of assimilation and adaptation occurred in already existing professional organizations and hospitals. In psychiatric facilities this heralded a long campaign to neutralize the damaging effect of the hospital environment on its inhabitants. As a result many changes aimed at humane and socially rational forms

https://journals.sagepub.com/doi/pdf/10.1177/070674377201700108

The descent of milieu therapy.

This paper describes a controlled trial of `therapeutic community' treatment of chronically disturbed men. It shows that the chronic schizophrenic group are improved clinically and that the chances of discharge from hospital, and of interaction between patients, are greater for all those treated by the therapeutic community method. These findings are discussed.

Results in a therapeutic community

A 60-bed therapeutic community in the male and female disturbed wards of an 800-bed general psychiatric hospital is described. From February, 1964, to February, 1969, there were 566 admissions of 267 persons. Characteristics and customs are analysed. Frequent themes of community preoccupation were: Rejection, Violence, Sexuality, Staff Divisions, Dependence—Independence and Relations with Outside Bodies.

David H. Clark

Papers

Results in a therapeutic community

Themes in a Therapeutic Community