Enduring mental illness

The therapeutic community approach(8) has been widely used in large mental hospitals to counter the effects of institutionalization and to mobilize the residual capacity of patients suffering from chronic mental disorder for social relationships, purposeful employment, and personal responsibility. The method was as much about improving the sense of purpose and morale of the staff and the general quality of life in the institutions as it was about clinical improvement, and its success was demonstrated in the way many large old mental hospitals were turned into centres of excellence. (28) With the re-provision of services for people with enduring mental illness in the community, therapeutic community principles have been found to be an effective way of structuring staffed hostels and homes. In one version of this, the 'ward in a house', the model is close to the original practice of the York Retreat, an antecedent of therapeutic communities (see above). (29>

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