Therapeutic community approach in secure settings for men with learning disabilities shows treatment gains in first 12 months

man at fence

The notion of the therapeutic community emerged in the 1940s and was developed in the UK throughout the subsequent decades. Therapeutic communities developed participative approaches to working with people with long term mental illness. Usually residential, they offered a complete therapeutic milieu with therapists and patients living in the same environment and within the same ‘rules’, with patients being seen as active participants in their own and each other’s treatment.

The researchers in this study were interested to apply the ideas behind the therapeutic community to a secure setting for men with mild learning disabilities and personality disorder.

They worked with an intervention group of over 11 men and compared this group on a number of measures with a pragmatic control group of 10 men, who were receiving treatment as usual. They did the work over a period of twelve months and collected information on violent incidents, seclusion hours, and informant and self-report clinical outcome measures at three time points – six months before, at six and 12 months after the start of the intervention.

What they found was that there were clinical changes in the therapeutic community group which showed comparatively less pathology over time and in relation to the comparison group.

They found though that change was more likely for scales that measured internalising problems rather than in those that measured externalising problems. They also found that the mean number of violent incidents did not reduce over time.

There was a strong trend towards reduction in seclusion hours in the treatment group over time and there were significant differences between groups found at the six and twelve month stages.

The authors point out that there is little literature on this approach in people with learning disabilities and that the sample size was very small. Literature in the mental health field has suggested a need for a minimum of 18 months in therapeutic community treatment to bring about treatment effects. At this point therefore, the findings are interim and they plan to complete a further evaluation after two years.

They conclude that their findings suggest that therapeutic community treatment as outlined in their study is consistent with involvement and choice and that the preliminary findings from this initial evaluation are promising, suggesting the theraprutic community approach may be a

potential mode of treatment suitable for a proportion of patients with learning disability in secure conditions.

Evaluation of a therapeutic community intervention for men with intellectual disability and personality disorder, Morrissey C et al., in Journal of Learning Disabilities and Offending Behaviour, 3 1,.52 – 60

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John Northfield

After qualifying as a social worker, John worked in community learning disability teams before getting involved in a number of long-stay hospital closure programmes, working to develop individual plans for people moving into their own homes. He worked for BILD, helping to develop the Quality Network and was editorial lead for the NHS electronic library learning disabilities specialist collection. This led him to found the Learning Disabilities Elf site with Andre Tomlin as a way of making the evidence accessible to practitioners in health and social care. Most recently he has worked as part of Mencap's national quality team and also been involved in a number of national website developments, including the General Medical Council's learning disabilities site.

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