- The concept of the therapeutic community was first developed by Maxwell in 1953 in his book "Social Psychiatry", which was later published in the United States as "Therapeutic Community". - Therapeutic communities aim to use a patient's social environment to provide a therapeutic experience and enable patients to actively participate in their own care. - Key elements of therapeutic communities include collective responsibility, citizenship, empowerment, avoiding dependency on professionals, and patients having significant involvement in decision-making.

1. -Mr. ANEEZ. K
Ist year M.Sc. Nursing
EMCH CON

2. 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.”

3. Small cohesive communities where
patients have a significant
involvement in decision-making and
the practicalities of running the
unit.

4. Collective responsibility
Citizenship
Empowerment
Encourages personal responsibility
Avoids unhelpful
dependency on professionals

5.  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.

6. 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.

7. To enable the patients to become
aware of how their behavior affects
others.

8. Dependence syndrome
Depressive disorders
Neurosis
Somatoform disorder
Personality disorder

9.  Self harming nature
Drug abuse
Violent patients
Schizophrenia
Enduring mental illness

10. Size of the unit
Duration of treatment
Relationship with the parents,
organizations and wider community

11.  Free communication
 Shared responsibilities
 Active participation
 Involvement in decision making
 Understanding of roles, responsibilities,
limitations and authorities

12. 1. 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.

13. 1. Daily Community meetings
 During discussions patient’s feelings and behaviors
are examined by other members.
 Frank discussions are encouraged
 much outpouring of emotions and anger.

14. 2. Patient Government or Ward council
 to deal with practical unit details
 A 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

15. 2. Patient Government or Ward council
 staff members should be available always.
 All decisions should be feedback to the
community through the community meetings.

16. 3. 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.

17. 4. Living and learning Opportunities
 provided within the social milieu
 provide realistic learning experiences for the
patients.

18. Psychiatrist
Psychiatric nurse
Clinical psychologist
Psychiatric social function

19. Occupational therapist
Recreational therapist
Art therapist
Music therapist
Dietician

20. Psychiatric nurse
 Authoritarian role
Social role
 Therapeutic role
Psychiatrist
 Leader
 Diagnose and treatment

21. Clinical psychologist
 Assist to diagnose by psychological
test
Psychiatric social worker
 Concerned with client need
 Fulfil family and community
requirement
Assist in conduction of therapeutic
skill

22. Recreational therapist
 Encourage to express their feeling
Occupational therapist
 Develop independent skill
 Assist to productive
 Creative activities and skills are
developed

23.  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.

24.  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.

25.  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.

26. 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

27. 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.

28. 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/thera
peutic-communication.html

29. ANY DOUBT