Milieu Therapy

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Milieu Therapy The Therapeutic Community
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Introduction

• The psychiatric-mental health nurse provides
  structures, and maintains a therapeutic
  environment in collaboration with the patient and
  other health care clinicians.
• Standard Vb of the American Nurses Association
  Standards of Psychiatric
• Mental Health Nursing Practice

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Milieu, Defined

• Milieu therapy, or therapeutic community, is
  defined as a scientific structuring of the
  environment to effect behavioral changes and to
  improve the psychological health and functioning
  of the individual.
• Within the therapeutic community setting, the
  patient is expected to learn adaptive coping,
  interaction, and relationship skills that can be
• generalized to other aspects of his
• or her life.

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Basic Assumptions

• The health of each individual is to be realized
  and encouraged to grow.
• Every interaction is an opportunity for
  therapeutic intervention.
• The client owns his or her own environment.
• Each client owns his or her own behavior.
• Peer pressure is a useful and powerful tool.
• Inappropriate behaviors are dealt with as they
  occur.
• Restrictions and punishment are to be avoided.

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Conditions that Promote a Therapeutic Community

• Basic physiological needs are fulfilled.
• The physical facilities are conductive to
  achievement of the goals of therapy.
• A democratic form of self-government exists.
• Unit responsibilities are assigned according to
  patient capabilities.
• A structured program of social and work-related
  activities is scheduled as part of the treatment
  program.
• Community and family are included in the program
  of therapy in an effort to facilitate discharge
  from the hospital.

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The Program of Therapeutic Community

• A treatment plan is directed by an
  interdisciplinary team.
• The plan is formulated by the team.
• Team members of all disciplines sign the plan and
  meet weekly to update the plan as needed.
• Disciplines may include psychiatry, psychology,
  nursing, social work, occupational therapy,
  recreational therapy, art therapy, music therapy,
  dietetics, chaplains service and family.
• The core team members are the psychiatry, nursing
  and social workers to have a treatment team
  meeting.

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Role of the Nurse

• Through use of the nursing process, nurses manage
  the therapeutic environment on a 24-hour basis.
• Nurses have the responsibility for ensuring that
  the patients physiological and psychological
• needs are met.
• Nurses are also responsible for
• Medication administration
• Development of a one-to-one relationship
• Setting limits on unacceptable behavior
• Recognizing positive behaviors
• Client education