Maintenance of therapeutic community principles in an age of biopharmacology and economic restraints.

The therapeutic community has changed significantly since its development in England more than 40 years ago. However, the hallmarks of the therapeutic milieu, such as patient participation in decision making, a multidisciplinary staff, and a belief that the environment is the treatment agent, remain part of many psychiatric settings. The therapeutic community will continue to undergo alteration to adapt to changes in society. It will continue to be a viable treatment modality as long as the value system of the organizational culture and the internal structure of the community are included as basic concepts. Systems theory and organizational culture concepts are used to explore the factors that enhance the functioning of a therapeutic community in an era of biological treatment and rising health care costs.