Milieu therapy

this presentation is about milieu therapy

1. MILIEU THERAPY OR THERAPEUTIC COMMUNITY BY- PREETI SHARMA MSC. NURSING 1 ST YEAR

2. INTRODUCTION ‘Milieu’ is a French word, means ‘Middle’ and ‘Surrounding or Environment’. The therapy which involves the ‘milieu’ or environment is called as ‘Milieu therapy or Therapeutic Community or Therapeutic Environment’. The concept of ‘Therapeutic Community’ was first developed by Maxwell Jones in 1953.

3. DEFINITION ‘The Psychiatric Mental Health Nurse structures, provides and maintains a therapeutic environment with the client and other health care clinicians’. – ANA, 2000 ‘A special kind of Milieu therapy in which the total social structure of the treatment unit is involved as a part of helping process. – Kraft

4. GOALS Changes maladaptive behavior into adaptive behavior Promotes early recovery. Minimizes prolongation of hospital stay. To resocialise the client. To promote self-confidence

5. OBJECTIVES To use patients social environment to provide a therapeutic experience for him. To enable the patient to be active participant in his own care and become involved in daily activities of his community. To help patients solve problems, plan activities and develop the necessary rules and regulation for the community.

6. ELEMENTS FREE COMMUNI-CATION SHARED RESPONSI-BILITY ACTIVE PARTICIP-ATION DECISION MAKING UNDERST-ANDING ROLES & RESPONS-BILITY

7. INDICATION PERSONALITY DISORDER

8. CONTRAINDICATION DEPRESSION

9. COMPONENTS DAILY COMMUNITY MEETINGS PATIENT GOVERNMENT OR WARD COUNCIL STAFF MEETINGS OR REVIEWS LIVING BAND LEARNING OPPORTUNITIES

10. DAILY COMMUNITY MEETINGS M eetings are composed of 60-90 patients Held regularly for 60 mn . Patient’s feelings and behaviors are examined by other members . Frank discussion are encouraged

11. PATIENT GOVERNMENT OR WARD COUNCIL Patient government is to deal with practical unit details such as housekeeping functions, activity planning and privileges . All decision should be feedback to the community through the community meetings.

12. STAFF MEETINGS OR REVIEWS Staff meeting should be held following each community meeting (patients are excluded and only staff are present). In this meeting the staff would examine their own responses, expectations, and prejudice’s.

13. LIVING BAND LEARNING OPPORTUNITIES Learning opportunities are to be provided within the social milieu, which should provide realistic learning experiences for the patients.

14. ADVANTAGES Patients develop harmonious relationships with other members of the community. Gains self-confidence. Develops leadership skills. Learns to understand and solve problems of self and others. Becomes socio-centric. To improve self-esteem. It creates positive attitude .

15. DISADVANTAGES Role blurring between staff and patient . Group responsibility can easily become nobody’s responsibility . Individuals needs and concern may not be met . Client may find the transition and difficulty to survive within the community .

16. TEAM IN MAINTENANCE OF THERAPEUTIC COMMUNITY Psychiatrist Clinical psychologist Psychiatric clinical nurse specialist Mental health technician Psychiatric social worker Occupational therapist Recreational therapist

17. CONT…. Music therapist Art therapist Psycho dramatist Dietician Chaplain

18. PROGRAMS WITHIN THE MILIEU CHART PAPER

19. KEY PARAMETERS IN SETTING UP Size of the unit The residents in a therapeutic community are 20-30. It allows the group members to experience a number of group situations and membership and everyone will know each other.

20. Duration of Treatment 9-18 months, it may be divided into different phases. In acute settings, shorter period and longer period for people with enduring mental illness. Relation with the Parents Organization and wider Community It is vital task for the long term survival and integrity of a therapeutic community.

21. ROLE OF NURSE Providing and maintaining a safe and conflict free environment through role modeling and group leadership. Sharing of responsibilities with patients. Encouraging patients to participate in decision making functions. Giving feedback. Carrying out supervisory function. Nurse ensures that clients’ needs are met.