Therapeutic community (TC) is a term applied to a participative, group-based approach to long-term mental illness, personality disorders and drug addiction and has gained some reputation for success in rehabilitation and patient satisfaction in Britain and abroad. In Britain, ‘democratic analytic’ therapeutic communities have tended to specialise in the treatment of moderate to severe personality disorders and complex emotional and interpersonal problems.
Background
Communities for the treatment of adult mental health ailments first emerged in a recognisable form in England during the Second World War at Northfield Military Hospital in Birmingham and Mill Hill in London. The leaders of the Northfield ‘experiments’ were psychoanalysts who were later involved in treatment programmes at the Tavistock Clinic and the Cassel Hospital, and had considerable international influence on psychoanalysis and group therapy.
The Mill Hill programme, for battle shocked soldiers, later led to the founding of the Henderson Hospital and a worldwide ‘social psychiatry’ movement, which led to considerably more psychological and less custodial treatment of inmates of mental hospitals everywhere. The number of specific TC units reached a peak in the 1970s, and fell for the following decades – although a new variant of TC, working with day treatment programmes instead of residential ones, has grown in numbers since the 1990s and is now finding a specific place in the treatment of personality disorders.
Principles of Prison Service Democratic Therapeutic Communities
The core principles of a TC were first articulated following a study at the Henderson Hospital (1960) in which it was sought to identify different themes of TC work and describe the function of each of them. The key principles are expressed as follows:
1. Democratisation – modelling a healthy society
2. Permissiveness – the freedom to express characteristic patterns of behaviour
3. Reality confrontation – peer pressure and peer support
4. Communalism – close knit intimate sets of relationships
This model adds three further core principles:
5. Living-Learning Situation – everything that happens between TC members is used as a learning opportunity
6. Culture of Enquiry – all aspects of the community are questioned and explored
7. Confidentiality/No secrets
The key principle is that as much responsibility as possible is delegated to the community as a whole. It is however important to recognise that prison TCs are not truly democratic because the power lies with the staff. Nevertheless, the principles that staff decisions are open to scrutiny and that certain decisions are made collectively are central. The TC with its structures of group decision-making and pro-social co-operation is intended to model a pro-social society outside prison.
Collective decision-making could be on such issues as: how to deal with infringements of rules; who is elected to important posts within the community; timetabling problems etc. In this way, members are required to take responsibility for the consequences of their decisions, and cannot revert to their usual defensive manoeuvres, such as leaving, misusing drugs, or blaming those in authority.
Prison traditionally takes all areas of decision making away from its residents. The opportunities to learn how to make difficult decisions and to face the consequences of having made a wrong decision are essential ingredients of the path to adulthood in a pro-social society. Thus, as many decisions as possible are delegated to the Community. This also means that in a majority vote, individuals may have to manage things ‘not going their way’.
Because modelling and personal accountability is so important, staff and residents are required to be willing to account for their actions to the rest of the Community.
Geographical location and number of places HMP Grendon – 235 places for Category B men (5 communities and an assessment unit) HMP Dovegate – 200 places for Category B men (4 communities, an assessment unit and a High Intensity Programme unit) HMP Gartree – 23 places for Category B lifers (1 community) HMP Aylesbury – 22 places for Young Offenders (1 community) HMP Blundeston – 40 places for Category C men (1 community) HMP Send – 40 places for women (1 community)
Democratic TCs should be distinguished from Drug Treatment TCs which are based on a different hierarchical model.