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Psychiatric-Mental Health Nursing

5.3 Community Support Systems

Psychiatric-Mental Health Nursing5.3 Community Support Systems

Learning Objectives

By the end of this section, you will be able to:

  • Describe a therapeutic community
  • List conditions that promote a therapeutic community
  • Identify members of the interdisciplinary treatment team
  • Discuss the nurse’s role in milieu therapy

When you think about community support systems, it is important to consider the environments in which care takes place as well as the people providing the care. Interprofessional teams are groups of professionals who work together toward a common goal or outcome when treating clients with mental illness. No two people respond exactly the same to treatment. It is important for people to learn how to develop their own community supports and learn to be their own advocates, through the help of referrals and resources from their primary care providers.

Therapeutic Community

A therapeutic community is a socially interactive approach to client treatment for mental health challenges and can include all types of programs, ranging from inpatient to outpatient, short- to longer-term. A therapeutic community works by having the clients interact with other people, make their own decisions, and contribute to decision-making for the community. In doing so, the clients learn new ways to approach/respond to the world around them (Stanborough, 2020). According to the National Institute on Drug Abuse (2015), therapeutic communities were initially developed as long-term residential treatment facilities for people with substance use disorders. Over the years, therapeutic communities have expanded to help people with an array of problems, such as “co-occurring psychiatric disorders [and] homeless individuals” (NIH, 2015, para 3).

Within a therapeutic community, a client strives to be an active participant in group activities, both learning how to achieve positive change and helping others with their recovery. The environment where therapy takes place is also referred to as the milieu. The therapeutic milieu is closely monitored for safety, has a daily routine, and occurs within inpatient and outpatient settings, and meetings (such as AA) or therapeutic groups.

Conditions That Promote Therapeutic Community

The underlying principle of a therapeutic community is that clients can use all the parts of the community in order to take care of themselves individually and collectively (Janeiro et al., 2018). Clients first learn how the community works, what is expected, and the intended goals for treatment. They then begin to interact with both staff and other clients. Through this process, clients learn to express their emotions safely. Through the education provided in the therapeutic community, the clients begin to see that psychological change is possible (Janeiro et al., 2018). They commit to change and to finding ways to apply the change to their lives.

What are the key components for a therapeutic community? Clients begin to develop a sense of hope for the future. Clients in these communities create a sense of belonging with the connections that form between themselves, staff, and other clients. Through their interactions, clients have opportunities to “develop life skills, and support in areas such as employment, funding and benefits, physical health, and relationship issues” (Wood et al., 2022, p. 7).

Interdisciplinary Treatment Teams

An interdisciplinary treatment team is one that may include psychiatrists, nurses, therapists, social workers, occupational therapists, recreation therapists, mental health technicians, and other team members, all working together toward the individualized goals of each client. This is not an all-inclusive list of interdisciplinary team members, as they may differ from facility to facility. According to Miller et al. (2022), for these teams to work well, there are several conditions. They must first have “material resources” (p. 15) that include being close enough in physical space and having the equipment needed to get the job done. There must be enough staffing to fill all the roles within the team. There must be enough time in the daily schedule to get the work completed. There must be organizational support that includes leaders who are knowledgeable and available to help with any treatment challenges faced by the team members. Lastly, the team members must have an established respect and trust of one another.

The Nurse’s Role in Milieu Therapy

Nurses constantly observe the ebb and flow of activity in the unit, quickly jumping into action at any indication of a change that may negatively affect the milieu to ensure the safety and therapeutic benefit of the milieu. The many roles of the registered nurse in milieu therapy include:

  • demonstrating caring behaviors to develop therapeutic relationships
  • providing care that focuses on the client
  • advocating for the needs of diverse populations across the life span
  • using critical thinking and technology solutions to implement the nursing process to collect, measure, record, retrieve, trend, and analyze data and information to enhance health-care consumer outcomes and nursing practice
  • partnering with the health-care consumers to implement the plan in a safe, effective, efficient, timely, and equitable manner
  • engaging with interprofessional team partners to implement the plan through collaboration and communication across the continuum of care
  • using evidence-based interventions and strategies to achieve mutually identified goals and outcomes specific to the problem or needs
  • delegating tasks according to the health, safety, and welfare of the health-care consumer and after considering the circumstance, person, task, direction or communication, supervision, and evaluation
  • knowing the state’s nurse practice act, relevant state and local regulations, and institutional policies, and maintaining accountability for the care
  • documenting implementation of and any modifications to the identified nursing care plan

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