The programmes are group-based, and the community itself is the primary therapeutic intervention: all members of the community are responsible for the day-to-day running of the unit and decisions are made by consensus or voting; members cook, eat and spend social time together. One of the most important TC principles has always been ensuring that patients take the lead in their own treatment, as well as contributing to the treatment of others - in contrast to the paternalistic attitudes taken by mainstream services. TCs have extended this practice so that that ex-service users and experts by experience are encouraged to become involved in teaching, training, research, service commissioning and consultancy. More recently, these practices have been adopted by other services in all areas of health and social care.
Although this discussion mainly concerns democratic therapeutic communities for people with mental health difficulties, there is also a very large worldwide contingent of addiction TCs; although their origins were very different to ‘democratic’ TCs, some commentators have noticed that they are becoming increasingly similar.
While the late 1980s and 90s saw the closure of many residential NHS TCs because of financial constraints, creative adaptations were taking place in order to survive. Two new national residential NHS TCs were set up to replicate the work of the flagship Henderson hospital; other NHS residential TCs responded to the challenge by converting to non-residential programmes, and a number of day TCs were established as part of the national personality disorder program in the early 2000s. Four new TC wings were established as part of a new purpose-built private prison; researchers in the TC field were awarded two major grants – one to undertake a systematic review of the evidence base in the TC literature, and the other for a multicentre comparative research study.
And apologies for the incomplete references – I’ll update it when I get a chance!