An implementation of therapeutic community in a private mental health center.

The concepts of milieu therapy have, in the past 20 years, been widely applied to various facilities for treatment of people with emotional and mental illness. One type of milieu therapy, the Therapeutic Community, has gained increasing acceptance, as a means of implementing milieu therapy. This paper describes the application of therapeutic community concepts to the in-hospital population of a private, open-staffed, open-door psychiatric facility, and some of the effects that this has had on both the staff, and the patient population. Since the development of the therapeutic community concept almost 25 years ago, programs have been developed in various centers which implement the concepts of social psychiatry in different ways. This paper describes the development of a particular therapeutic community on the in-patient adult and adolescent psychiatric services of a private psychiatric hospital. Parkwood was developed as a small (40 bed) psychiatric hospital in Atlanta, Georgia in 1966 by a group of physicians wanting to implement the ideas of milieu therapy in an area where no such program was available. In its initial stages, the hospital -- of attractive, middle-class decor -- was built in a wooded setting on the edge of a large metropolis. It was open-staffed, with psychiatrists having an eclectic, though psychoanalytically based, orientation toward treatment. The concepts of milieu therapy were interpreted to mean the following: a warm, pleasant atmosphere, in pleasant surroundings, conducive to the usual brief psychotherapy, chemotherapy, or somatic therapy, which had previously been used in non-milieu psychiatric hospitals. The total hospital patient population was divided in half and met in group sessions with a psychiatrist once each week. The Medical Director, a psychiatrist, had weekly staff meetings, in which he discussed various administrative problems. In 1969, a Medical Director with a therapeutic community orientation was employed. Over a five-year period, the total complexion of the hospital changed to its present state, an open-staffed, open door, comprehensive, community mental health center financed on a private basis. The facility now provides out-patient, partial or total hospitalization, emergency services, and community education for children, adolescents, adults and alcohol addicted patients. This paper deals with the therapeutic community on the adult and adolescent units.