Therapeutic community n

Mental health nursing.

Submitted to : Mrs. Smrutirekha parida

The concept of therapeutic community was first developed by Maxwell Jones in 1953. 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."

Definition
Stuart and Sundeen defined therapeutic community as,
"a therapy in which patient's social environment would be used to provide a therapeutic experience for the patient by involving him as an
active participant in his own care and the daily problems of his community."

A therapeutic community is a drug free environment in which people with addictive problems live together in an organized and
structured way in order to promote change and make possible a drug-free life in the outside society. The therapeutic community forms
a miniature society in which residents and staff in the role of facilitators, fulfill distinctive roles and adhere to clear rules, all designed to
promote the transitional process of the residents.

- Ottenberg , 1993.
 Objectives
~Use patient's social environment to provide a therapeutic experience for him
~Enable the patient to be an active participant in his own care and become involved in daily activities of his
community.
~ Help patients solve problems, plan activities and develop the necessary rules and regulations for the community.
~ Increase their independence and gain control over many of their own personal activities.
~ Enable the patients become aware of how their behavior affects others.
key characteristics of thereapeptic Communities
1. Community-based : TCs are typically located in residential settings, such as

hospitals ,clinics ,or community centers.

3. Social learning : TCs use social learning principles to promote positive behaviours and

attitudes.
4. Group works : TCs emphasize group therapy and activities to foster socialization and
community building.
5. Democratic : TCs often involve patients in decision-making processes and encourage

self-governance.
Elements of
Therapeutic Community
Free communication
Shared responsibilities
~ Active participation
Involvement in decision making
Understanding of roles, responsibilities,
limitations and authorities
components of therapeutic
community
The main components of a therapeutic community are daily community meetings,
patient government, staff meetings and living and learning opportunities
1. Daily, Community Meetings
~ These meetings are composed of 60-90 patients. All levels of unit staff are involved including administrative personnel.
Acute patients are not involved in the meetings.
~ Meetings should be held regularly for 60 minutes
~ Discussion should focus mainly on day-to-day life in the unit.
~ During the discussion patient’s feelings and behaviours are examined by other members
~ Frank discussion are encouraged. These may take place with much outpouring of emotions and anger.
2. Government or Ward Council
~ The purpose of patient government is to deal with practical unit details
such as house-keeping functions, activity planning and privileges.
~ A group of 5-6 patients will have specific responsibilities such as
housekeeping, physical exercise, personal hygiene, meal distribution, a
group to observe suicidal patients, etc. Staff members should always be
available.
~ All decisions should be fed back to the community through community
meetings.
3.Staff Meetings or Review
A staff meeting should be held following each community
meeting wherein the patients are excluded and only the
staff are present. In this meeting the staff would examine
their own responses, expectations, and prejudices.
4. Living and Learning Opportunities
Learning opportunities are to be provided within the
social milieu which should provide realistic learning
experiences for patients.
Benefits of Therapeutic Communities
~ Improved social skills
~ Increased self-esteem
~ Better symptom management
~ Reduced hospitalisation
~ Improved quality of life
Advantages of Therapeutic Community
~ Patient develops harmonious relationships with other members
of the community.
~ Gains self-confidence.
~Develops leadership skills.
~Learns to understand and solve problems of self and others.
~ Becomes sociocentric.
~ Learns to live and think collectively with the members of the community.
~ Lastly, therapeutic community provides opportunities to participate in
the formulation of hospital rules and regulationsthat affect patient's
personal liberties like bedtime, mealtime, weekend permission,
control of radio or TV, social activities, late night privileges, etc.
Disadvantages of Therapeutic Community
* Role blurring between staff and patient.
* Group responsibility can easily become
nobody's responsibility.
* Individual needs and concerns may not
be met.
* Patient may find the transition to community difficult
Role of Nurse
*Providing and maintaining a safe and conflict free environment through role
modeling and group leadership.
*Sharing of responsibilities with patients.
*Encouraging patient to participate in decision-making functions.
Assisting patients to assume leadership roles.
*Giving feedback.
*Carrying out supervisory functions.
Conclusion :
Therapeutic community is an approach
which is
* Democratic as opposed to hierarchical.
* Rehabilitative rather than custodial
* Permissive instead of limited and
controlled.
Sum
mary
Therapeutic communities are summerized as a valuable approach in mental health nursing
,
offering a supportive,social,and empowering environment for patients.
By understanding the key characteristics, goals,and roles of TCs, mental health nurses can
provide effective care and support to individuals with mental health conditions.
Thank
you 🙏