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Therapeutic communities (and many other residential services) have been effectively marginalised in recent years with the increasing popularity of community-based outpatient responses to a variety of social issues including addiction, learning difficulties, mental health issues, etc. The paper aims to discuss this issue.

This has inevitably led to a low profile and has resulted in a lack of knowledge about therapeutic communities and how the methodology differs significantly from other approaches.

This situation is beginning to change in a number of fields and it is important that the therapeutic community movement adapts its methodology to the needs of their respective client groups and clarifies its approach (and the efficacy of that approach) to funders and service commissioners.

This paper is a personal contribution.

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.

A structured literature review of TC in ID services.

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.

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.

Since the late 1980s, the Brazilian Psychiatric Reform, alongside the anti-asylum movement, has promoted a change in the way of treating people with mental suffering in the country. This process produced transformations in the flows and forms in which individuals with mental illnesses use the city, intending to make the city itself less unequal.

Taking into account that accessibility measures must consider individual, temporal, transportation and land-use elements as relevant, this study will focus on the relation between mobility and access, looking at subjects who were submitted to prolonged psychiatric hospitalisation and got discharged to live in the Residential Therapeutic Services – RTS, in Belo Horizonte, Brazil. In order to do that, the study used focus groups, observation, shadowing and in-depth interviews as methodologies strategies.

The results of the study demonstrate that: (a) there are a variety of ways of accessing the city; (b) displacements outside the facilities are characterised by the proximity of the destinations and by being made, mostly, on foot; (c) there is a restriction regarding the use of public transport system; and (d) access to money is a determinant factor for the accomplishment of mobility practices in city spaces. However, it is also observed that the mobility and access to the city can exert an effect of autonomy by allowing governance of the subjects’ own time and destination.

The purpose of this paper is to investigate the views of young adult prisoners with emerging personality disorders (PDs), who were assessed as posing a high risk of causing serious harm to others, on the process of therapeutic change in a non-residential treatment service in a UK young offender institute. The treatment model utilises an integrated approach, specifically adapted for the developmental needs of young adults and combining therapies for PD with offence focussed interventions and regular keywork.

In total, 13 participants, who had completed at least one year of therapy, were interviewed about their perspectives about what, if any, change had occurred and how any reported change had taken place. The interviews were transcribed verbatim and analysed via thematic analysis.

All participants described having made positive therapeutic change. Three overarching change themes were identified: mentalisation of others, self-knowledge and adaptive coping. Relationships with staff were described as the key mechanism through which change was achieved. Specific treatment interventions were mentioned infrequently, although keywork and generic individual therapy and groupwork sessions were also described as drivers to change.

The findings suggest the possibility of positive therapeutic outcomes for this complex service user group. They also suggest that the domains of change and associated mechanisms may be similar to those reported for other service user groups and in other settings.

A system of care is a function-specific, rather than agency-specific approach defined as a “comprehensive spectrum of mental health and other necessary services which are organized into a coordinated network to meet the multiple and changing needs of children and adolescents with severe emotional disturbances and their families” (Stroul & Friedman, 1986). A system of care provides a mental health delivery system for children with SED with a wide array of accessible, community-based services that focus on children's individual needs, include the family in treatment planning, and provide culturally competent services. System of care services are provided by multiple child serving agencies and are collaborative and coordinated (Stroul & Friedman, 1986).

The purpose of this paper is to report on the point of view of architecture of an interdisciplinary research on housing and social integration of people with severe mental disorder (SMD) in Brazil after deinstitutionalization. It first aims to present the need for a qualitative evaluation of the way people with SMD deal with their living spaces (house and city); then to describe the method adopted to approach people living under control – in therapeutic residential services (SRTs) proposed by the State as the only alternative model for those leaving psychiatric institutions – and people living alone – with little psychiatric assistance and no dwelling support provided by the State. It aims to conclude with a discussion of the observed dwellings pointing towards the need to accommodate differences in any housing model adopted by the State.

The qualitative evaluation enabled the focus of participant observation on the way people interact with each other and with their living space. The authors followed the routines of chosen people with SMD in three different cities in Brazil and provided reports for the whole group to analyze them.

It was found that those living in SRTs are much more obstructed by institutional control than those living alone. Despite the difficulties and fragilities of those living alone because of the lack of support, they end with more possibilities for autonomy and social integration.

Most research on the subject approaches objective housing issues focusing on statistical results. This research evaluates qualitative dwelling issues, summarizing little pointers for future health policy on housing for people with SMD.

Philanthropy takes many forms among African immigrant communities. It exists in the form of mutual aid for friends, extended family, lineage, and fictive kin. This last category includes, but is not limited to, those from an individual’s ethnic group, or even from their country of origin. Philanthropy is also to be found in the form of kindness and generosity toward strangers. Above all, elements of philanthropy are to be found in the corporatization of community-based efforts to develop the human and material resources among many African ethnic groups. Many studies of the process of urbanization in Africa indicate the ubiquity of formation of hometown organizations that perform social functions including philanthropy among newly urbanized Africans. These organizations assist urbanized home folk from the villages and the towns of origin from which these urbanized groups originally emerged in various respects. The assistance offered include giving material and moral support in times of significant social celebration and mourning, for education as well as for home construction, construction of infrastructure for the home community, and for various other community-based development efforts. The efforts of African immigrants in the United States and elsewhere closely follow the patterns described above. The patterns are so ubiquitous as to warrant a claim of their emergence from a philosophical orientation toward philanthropy in African society.

In the desire to improve outcomes for children in care, the issue of those individuals placed by local authorities in residential establishments run by external agencies has become especially salient. In addition to questions of quality and value for money, there are concerns about children becoming detached from local services, especially as many of the placements selected are outside the local authorities' geographical boundaries. This study looks at 262 children so placed in eight English local authorities. It was found that although there were common presenting problems, such as a need for specialist therapy or to reduce difficult behaviour, the children's circumstances varied and four distinct groups of children with common needs were identified. The use of such placements also varied across the authorities and did not mirror their numbers of children in care. The factors associated with the use of externally purchased residential placements and differences between those placed internally and externally are explored. A framework for developing new approaches for difficult adolescents and suggestions about fruitful service development are offered.