this presentation is about milieu therapy

2. MILIEU THERAPY OR
THERAPEUTIC COMMUNITY
BY-
PREETI SHARMA
MSC. NURSING 1ST YEAR

3. INTRODUCTION
• ‘Milieu’ is a French word, means ‘Middle’ and
‘Surrounding or Environment’.
• The therapy which involves the ‘milieu’ or
environment is called as ‘Milieu therapy or
Therapeutic Community or Therapeutic
Environment’.
• The concept of ‘Therapeutic Community’ was
first developed by Maxwell Jones in 1953.

4. DEFINITION
• ‘The Psychiatric Mental Health Nurse
structures, provides and maintains a
therapeutic environment with the client and
other health care clinicians’.
– ANA, 2000
• ‘A special kind of Milieu therapy in which the
total social structure of the treatment unit is
involved as a part of helping process.
– Kraft

5. GOALS
• Changes maladaptive
behavior into adaptive
behavior
• Promotes early recovery.
• Minimizes prolongation
of hospital stay.
•To resocialise the client.
• To promote self-
confidence

6. OBJECTIVES
• To use patients social environment to provide a
therapeutic experience for him.
• To enable the patient to be active participant in
his own care and become involved in daily
activities of his community.
• To help patients solve problems, plan activities
and develop the necessary rules and regulation
for the community.

7. ELEMENTS
FREE
COMMUNI
-CATION
SHARED
RESPONSI
-BILITY
ACTIVE
PARTICIP-
ATION
DECISION
MAKING
UNDERST
-ANDING
ROLES &
RESPONS
-BILITY

8. INDICATION
PERSONALITY DISORDER

9. CONTRAINDICATION
DEPRESSION

10. COMPONENTS
DAILY
COMMUNITY
MEETINGS
PATIENT
GOVERNMENT
OR WARD
COUNCIL
STAFF
MEETINGS OR
REVIEWS
LIVING BAND
LEARNING
OPPORTUNITIES

11. DAILY COMMUNITY
MEETINGS
•Meetings are composed
of 60-90 patients
• Held regularly for 60
mn.
• Patient’s feelings and
behaviors are examined
by other members.
• Frank discussion are
encouraged

12. PATIENT GOVERNMENT OR
WARD COUNCIL
•Patient government is to
deal with practical unit
details such as housekeeping
functions, activity planning
and privileges.
•All decision should be
feedback to the community
through the community
meetings.

13. STAFF MEETINGS OR
REVIEWS
Staff meeting should be
held following each
community meeting
(patients are excluded and
only staff are present). In
this meeting the staff
would examine their own
responses, expectations,
and prejudice’s.

14. LIVING BAND LEARNING
OPPORTUNITIES
Learning opportunities
are to be provided
within the social milieu,
which should provide
realistic learning
experiences for the
patients.

15. ADVANTAGES
• Patients develop 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 socio-centric.
• To improve self-esteem.
• It creates positive attitude.

16. DISADVANTAGES
• Role blurring between staff and patient.
• Group responsibility can easily become
nobody’s responsibility.
• Individuals needs and concern may not be met.
• Client may find the transition and difficulty to
survive within the community.

17. TEAM IN MAINTENANCE OF
THERAPEUTIC COMMUNITY
• Psychiatrist
• Clinical psychologist
• Psychiatric clinical nurse specialist
• Mental health technician
• Psychiatric social worker
• Occupational therapist
• Recreational therapist

18. CONT….
• Music therapist
• Art therapist
• Psycho dramatist
• Dietician
• Chaplain

19. PROGRAMS WITHIN THE
MILIEU

20. KEY PARAMETERS IN
SETTING UP
• Size of the unit
The residents in a therapeutic community
are 20-30. It allows the group members to
experience a number of group situations and
membership and everyone will know each
other.

21. • Duration of Treatment
9-18 months, it may be divided into different
phases. In acute settings, shorter period and
longer period for people with enduring mental
illness.
• Relation with the Parents Organization and
wider Community
It is vital task for the long term survival and
integrity of a therapeutic community.

22. ROLE OF NURSE
• Providing and maintaining a safe and conflict
free environment through role modeling and
group leadership.
• Sharing of responsibilities with patients.
• Encouraging patients to participate in decision
making functions.
• Giving feedback.
• Carrying out supervisory function.
• Nurse ensures that clients’ needs are met.