Therapeutic communities for people with intellectual disability and complex needs
| DOI | https://doi.org/10.1108/AMHID-05-2014-0014 |
| Date | 05 May 2015 |
| Pages | 124-131 |
| Published date | 05 May 2015 |
| Author | Jon Taylor,Simon Crowther,Christian Bryant |
| Subject Matter | Health & social care,Learning & intellectual disabilities |
Therapeutic communities for people with
intellectual disability and complex needs
Jon Taylor, Simon Crowther and Christian Bryant
Jon Taylor is Consultant
Psychologist at the Department
of Psychology, St Andrews
Healthcare, Mansfield,
Nottinghamshire, UK.
Dr Simon Crowther is based at
Calderstones NHS Trust,
Clitheroe, UK.
Christian Bryant is based at
National High Secure Learning
Disability Service, Rampton
Hospital, Retford, UK.
Abstract
Purpose –The purpose of this paper is to describe the use and value of therapeutic communties (TCs) in
services for people with intellectual disabilities (IDs) and complex needs.
Design/methodology/approach –A structured literature review of TC in ID services.
Findings –TCs have been used in a range of in-patient services for people with IDs. Although outcome
studies are scarce, those that exist offer promising indications of such service designs.
Originality/value –TCs have seen a recent increase of interest in ID services. This paper provides an
overview of these services and outlines the benefits that such a residential culture can offer for both service
users and staff members.
Keywords Intellectual disability, Complex needs, Offending behaviour, In-patient, Residential culture,
Therapeutic community
Paper type General review
Introduction
When the Panorama editorial team sent an undercover reporter into Winterbourne View the
resultant coverage of abuse within the residential context lead to widespread condemnation,
criminal prosecutions and a far-reaching review of national legislation. In the immediate aftermath
of the BBC broadcast the Department of Health (2012) proposed the closure of a significant
number of assessment and treatment beds for people with intellectual disability (ID), arguing that
the in-patient treatment, even when delivered in a professional and ethical manner, is
inappropriate for many people with ID. A response to these proposals from the Royal College of
Psychiatrists (2013) argued that in-patient care remains an important component of services
available to people with ID, citing the Royal Colleges peer-review mechanisms as a suitable
method for monitoring and reviewing the quality of care delivered within such settings. However,
neither the Department of Health, nor the Royal College of Psychiatrists set out the design
features of a residential setting for people with ID and complex needs.
This paper presents one such possible design for in-patient and residential services: a
therapeutic community (TC). A brief description of the philosophical principles and operating
practices of such treatment services is provided, followed by a brief history of TCs in services for
people with complex needs. An overview of the different types of TCs that have been used to
inform residential services for this population is then provided and the paper is concluded with a
brief review of the outcome research for such services as it currently stands.
TCs: principles and practices
The Association of Therapeutic Communities (ATC) describe TCs as “psychologically informed
planned environments”; environments where the social relationships, the structure of the day and
different activities are all deliberately designed to help people’s health and well-being. TCs are
Received 5 May 2014
Revised 11 November 2014
Accepted 26 January 2015
PAGE124
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ADVANCESIN MENTAL HEALTH AND INTELLECTUAL DISABILITIES
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VOL. 9 NO. 3 2015, pp.124-131, © Emerald Group Publishing Limited, ISSN 2044-1282 DOI 10.1108/AMHID-05-2014-0014
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