THERAPEUTIC

COMMUNITY

-Mr. ANEEZ. KIst year M.Sc. Nursing

EMCH CON

The concept of therapeutic community was first developed by Maxwell in1953.

He wrote a book entitled “ social psychiatry” which was first published in England.

Later on when it was published in the United states, its title was changed to “Therapeutic Community.”

THERAPEUTIC COMMUNITY Small cohesive communities

where patients have a significant involvement in decision-making and the practicalities of running the unit.

THERAPEUTIC COMMUNITY

Collective responsibility

Citizenship

Empowerment

Encourages personal responsibility

Avoids unhelpful dependency on professionals

OBJECTIVES To use patient’s social environment

to provide a therapeutic experience for him.

To enable the patient to be an active participant in his own care and become involved in daily activities of his community.

OBJECTIVES To help patients to solve problems

plan activities and to develop the necessary rules and regulations for the community

To increase their independence and gain control over many of their own personal activities.

OBJECTIVES To enable the patients to become

aware of how their behavior affects others.

INDICATION OF TC Dependence syndrome Depressive disorders Neurosis Somatoform disorder Personality disorder

Self harming nature Drug abuse Violent patients Schizophrenia Enduring mental illness

KEY PARAMETER IN SETTING OF TC

Size of the unit Duration of treatment Relationship with the parents,

organizations and wider community

ELEMENTS OF THERAPEUTIC COMMUNITY Free communication Shared responsibilities Active participation Involvement in decision making Understanding of roles, responsibilities,

limitations and authorities

COMPONENTS OF THERAPEUTIC COMMUNITY1. Daily Community meetings

composed of 60-90 patients. All levels of unit staff are involved

including administrative personnel acute patients are not involved in the

meetings. Discussion should focus mainly on day to day

life in the unit.

COMPONENTS OF THERAPEUTIC COMMUNITY1. Daily Community meetings

During discussions patient’s feelings and behaviors are examined by other members.

Frank discussions are encouragedmuch outpouring of emotions and anger.

COMPONENTS OF THERAPEUTIC COMMUNITY2. Patient Government or Ward council

to deal with practical unit detailsA group of 5-6 patients will have specific

responsibilities , such as house keeping physical exercise personal hygiene meal distribution a group to observe suicidal patients

COMPONENTS OF THERAPEUTIC COMMUNITY2. Patient Government or Ward council

staff members should be available always.All decisions should be feedback to the

community through the community meetings.

COMPONENTS OF THERAPEUTIC COMMUNITY3. Staff Meetings or Review

A staff meetings should be held following each community meetings

patients are excluded and only staff are present

In this meeting the staff would examine their own responses, expectations and prejudices.

COMPONENTS OF THERAPEUTIC COMMUNITY4. Living and learning Opportunities

provided within the social milieuprovide realistic learning experiences for the

patients.

STAFF IN TC Psychiatrist Psychiatric nurse Clinical psychologist Psychiatric social function

Occupational therapist Recreational therapist Art therapist Music therapist Dietician

ROLE OF STAFF Psychiatric nurse

Authoritarian roleSocial roleTherapeutic role

PsychiatristLeaderDiagnose and treatment

Clinical psychologistAssist to diagnose by psychological test

Psychiatric social workerConcerned with client needFulfil family and community requirement

Assist in conduction of therapeutic skill

Recreational therapistEncourage to express their feeling

Occupational therapistDevelop independent skillAssist to productiveCreative activities and skills are developed

ADVANTAGES OF THERAPEUTIC COMMUNITY Patient develop harmonious relationships

with other members in the community. Gains self confidence Develops Leadership skills. Learns to understand and solve problems

of self and others. Becomes Socio- Centric.

Learns to live and think collectively with the members of the community

provides opportunities to participate in the formulation of hospital rules and regulations that affect patient’s personal liberties like bedtime , meal time, weekend permission, control of radio or T.V, Social activities, late night privileges, etc.

ADVANTAGES OF THERAPEUTIC COMMUNITY

DISADVANTAGES OF THERAPEUTIC COMMUNITY Role blurring between staff and patients Group responsibility can easily become

nobody’s responsibility. Individual needs and concerns may not

be met. Patient may find the transition to

community difficult.

ASSIGNMENT Identify the difference between

therapeutic community and milieu therapy in detail and submit it on 21.8.2015 before 4 pm. Total mark is 20

REFERENCES Townsend M C. Psychiatric Mental

Health Nursing-concepts of care. (3 rd edition). F.H Davis Publishers; Philadelphia: 2000. Pg.No. 158-160.

Kapoor B. Text book of psychiatric nursing. Publishers of medical and nursing books; Delhi: 2006.Pg.No. 12-57.

Sreevani R.A guide to mental health and psychiatric nursing. Jaypee Brothers Medical Publishers; New Delhi: (2006). Pg.No. 148-149.

Stuart gail.w. principles & practices of Psychiatric Nursing. (9th edition). Elsevier publishers: 2011. Pg. No. 115-120.

www.austinecc.edu/richb/thercom.html

http//nursing.planet.com/pn/therapeutic-communication.html

ANY DOUBT