The closure of a therapeutic community in a forensic unit

I see how well it works with the residents first-hand and how it helps them to prepare for living back in the community. I am therefore very passionate that the TC approach works well and that it is an excellent way to see the residents develop relevant living skills.

A TC in the UK is best described as a community where residents live and have an involvement in how it is run and practice the skills of everyday living. The use of TCs are also being tried within the prison services - they help encourage behavioural change and responsible living (Campling 2001). Several studies have found that this approach to treatment is successful in substantially improving the quality of life for members. A study of patients at the Cassel Hospital showed that 98% of patients are too disturbed on admission to find employment, but that five years later 90% have jobs. Re-admission and re-conviction rates have been found to drop considerably after treatment in a therapeutic community (Rethink 2009).

The TCs were developed from the studies in 1942 to 1948 known as ‘Nothfield experiment’. As the formal psychotherapeutic approach was unsuccessful in the first place, psychiatrists from Northfield decided to focus on the whole unit by structuring the wards as communities. In the 1960s and 1970s many TCs were set up around the country. The first documented TCs in psychiatry in the UK were the Cassell Hospital, which was associated with Tom Main (he coined the term TC), and the Bethlem hospital - later known as Henderson Unit, which closed two years ago and was associated with Maxwell Jones who coined the term ‘living/learning experience’. The first known prison that used the TC approach was opened in 1962 at HMP Grendon. Grendon prison helped male prisoners at the end of their sentence to be ready to go back into the community (Kennedy 2004). Grendon was able to offer an environment where aberrant behaviours that occur in day to day living could be treated in a small group and community meeting process (Brookes 2009). There are still two units being used within the Cambridge area - ‘Winston House’ and ‘Glebe House’. In East Sussex there is one called ‘Mount Lodge’ which houses 15 residents with schizophrenia and is privately funded.

With a new forensic unit in the south coast opening, the TC approach has been removed and will no longer be part of the women’s rehab back into the community. I feel that the TC approach has been removed because of financial reasons; the NHS paid out for the women to buy and cook their own food. Now the women will be provided with a cooked chilled meal which is a cheaper option as all they have to do is put the food in an oven and no is preparation required. I am upset that this has been taken away from them as I could see how the skills the women were gaining were essential for future preparation to being released back into the community. Clark (1996) wrote in his report that therapeutic communities are being closed due to the ‘incompatibility of an egalitarian, democratic ward culture with the authoritarian, bureaucratic organisation that the NHS has become’. NHS managers were under pressure in the 1990’s to save money, cut costs and keeping everything under control, so the first thing to go was the TCs (Clark 1996). Perhaps history is repeating itself in the 21st century.

I spoke with one of the residents from the unit about her thoughts and feelings about the removal of the TCs. Sally (name changed) spoke about the way it is run and how it has helped her live in a community-based environment. She stated that she finds doing her chores three times a-week and being able to cook dinner for her peers a wonderful experience. Sally stated the environment is a network where they eat, chat and live together in a caring setting. The negative side she says is when fellow peers do not do their chores or keep the unit tidy. Overall Sally said that she is ‘wholly behind the concept and actualisation of therapeutic communities’.

Why does the TC approach have to be removed when they are such a great rehab process for residents to help prepare for their release? There is evidence that shows they are successful. I hope that in the future the TC approach will come back into service and allow people the chance to prepare for their release in a therapeutic environment.

Victoria Spurgeon is a 3rd year DipN mental health Student at Brighton University.

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