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Article
Publication date: 25 November 2020

Oliver Dale, Rex Haigh, Julia Blazdell and Faisil Sethi

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Abstract

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Mental Health Review Journal, vol. 25 no. 4
Type: Research Article
ISSN: 1361-9322

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Article
Publication date: 2 December 2020

Jan Lees, Rex Haigh, Simone Bruschetta, Anando Chatterji, Veronica Dominguez-Bailey, Sandra Kelly, Aldo Lombardo, Shama Parkhe, Joāo G. Pereira, Yousuf Rahimi and Barbara Rawlings

This paper aims to describe a method of training for practitioners in democratic Therapeutic Communities (TCs) which has been used in several settings across the world…

Abstract

Purpose

This paper aims to describe a method of training for practitioners in democratic Therapeutic Communities (TCs) which has been used in several settings across the world over the past 25 years: the “Living-Learning Experience” (LLE) workshop. It goes on to consider the cross-cultural implications of the work.

Design/methodology/approach

Drawing on the experience of running exactly the same programme in different countries and cultures, the paper examines the cross-cultural adaptability and describes necessary adaptations for local circumstances. It also contains original ethnographic research in UK and Italy; further study is planned for other countries.

Findings

The workshops are readily transferable to different cultures and are appreciated for their democratic and relational way of working.

Research limitations/implications

The ethnographic study examines the workshops in some depth, in UK and Italy, and could usefully be replicated in other countries. No quantitative, outcome or follow-up studies have yet been done, and this paper could contribute to the design of useful quantitative studies.

Practical implications

The paper demonstrates that the LLE is a useful experiential learning tool in widely different settings. It could be developed in different ways, such as for developing relational practice or establishing therapeutic environments in different settings.

Social implications

The workshops' acceptance in widely different cultures indicates that the open and non-didactic format addresses essential and fundamental qualities required for therapeutic engagement and human relatedness.

Originality/value

This is the first description of the principles of democratic TCs being applied across different international settings. Its value extends beyond the TC field, to the use of democratic and relational principles' applicability in therapeutic pedagogy and training.

Details

Therapeutic Communities: The International Journal of Therapeutic Communities, vol. 42 no. 1
Type: Research Article
ISSN: 0964-1866

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Article
Publication date: 11 September 2017

Steve Pearce and Rex Haigh

The purpose of this paper is to provide an overview of the application of therapeutic community (TC) method in non-TC environments.

Abstract

Purpose

The purpose of this paper is to provide an overview of the application of therapeutic community (TC) method in non-TC environments.

Design/methodology/approach

Milieu treatment is defined and differentiated from TC “proper”. Literature is reviewed covering attempts to use TC methods in inpatient wards, across hospitals, and more recently in the criminal justice system and more widely through the enabling environments initiative.

Findings

It is unclear whether TC milieu treatments proved helpful in acute ward environments in their heyday in the 1950s, 1960s and 1970s, in particular those involving people suffering from acute psychosis, and the changing landscape of psychiatric provision may make further investigation difficult. The reasons for this, and for the difficulties reaching a firm conclusion, are outlined. In contrast, TC milieu interventions appear to be demonstrating usefulness more recently in less mixed populations without the implementation of full TC “proper”.

Research limitations/implications

Much of the research is old and the methodology poor, which limits the conclusions that can be drawn.

Practical implications

Recent innovations pick up in a more accessible way principles of therapeutic communities that can inform and improve care in a variety of contexts. They are sufficiently well defined to lend themselves to research, which should now be a priority.

Originality/value

After a gap in developments in the field, recent innovations are reintroducing elements of TC functioning to new contexts including criminal justice settings, inpatient wards, homeless shelters and city communities.

Details

Therapeutic Communities: The International Journal of Therapeutic Communities, vol. 38 no. 3
Type: Research Article
ISSN: 0964-1866

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Article
Publication date: 13 November 2019

Jan Lees, Fiona Lomas and Rex Haigh

The purpose of this paper is to describe the role of the expert by experience, and its benefits and challenges.

Abstract

Purpose

The purpose of this paper is to describe the role of the expert by experience, and its benefits and challenges.

Design/methodology/approach

Review of the relevant literature and a case study has been performed.

Findings

The role of the expert by experience is fluid and complex. Staff need to understand the ambiguities of the role.

Practical implications

Experts by experience (XBXs) play an important role in TC practice. They need support and supervision. Staff need to learn about the complexities and fluidity of the role, and to be aware of its transitional position between service user and staff member.

Social implications

XBXs challenge the binary notion of staff and service user. The role calls for a different relational rather than procedural conceptualisation.

Originality/value

This is the first description of the lived experience of an expert by experience, working in a therapeutic community setting, with the analysis of the helpful and unhelpful aspects of the role.

Details

Therapeutic Communities: The International Journal of Therapeutic Communities, vol. 40 no. 3/4
Type: Research Article
ISSN: 0964-1866

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Article
Publication date: 8 July 2019

Rex Haigh and Nick Benefield

The purpose of this paper is to collaborate across disciplines to agree a better map of human development.

Abstract

Purpose

The purpose of this paper is to collaborate across disciplines to agree a better map of human development.

Design/methodology/approach

This paper used an iterative process of consultation with professionals and specialists in relevant disciplines, and service users, continually refining the diagram and text until a “good enough” consensus was reached to produce a diagrammatic form and explanatory text.

Findings

The process revealed a strong commitment across many disciplines to find a common contextual framework within which specialist understandings could be accommodated. The consultation process and iterative development of the diagram and text was marked by widespread interest and many detailed discussions. The substance of this paper is the result of that process.

Research limitations/implications

The model places research in different specialist fields onto a single “map of the territory”. It can encourage collaboration across disciplines when they are studying similar areas from different perspectives. It indicates the value of collaborative rather than competitive research enterprises.

Practical implications

Too often, professionals involved in fields concerning human development become focussed within narrow frameworks of specialisation. The model supports better understanding of how different elements relating to developmental life interrelate. This can facilitate the basis upon which a wide range of training, education and research programmes can be formulated.

Social implications

The model proposes greater use of a “whole-person/whole-life” perspective, which should allow greater integration between disparate approaches, and less experience of fragmentation. For a wide range of public sector activities, the quality of relational activity should be central to effective organisational and human outcomes. Without a unifying context, the understanding required to support relational work is weak: this model ad-dresses that deficit.

Originality/value

This work is entirely original. It should be of value to all those interested in working in holistic ways; to policy makers wishing to avoid duplication, waste and ineffective interventions; and to researchers interested in working across disciplinary boundaries. Most importantly, it is for staff involved in health, justice, social care and education services at all levels. Their effectiveness relies on relational, as well as procedural working, and this model will support confidence in the primacy of these activities.

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Article
Publication date: 12 June 2017

Sacha Evans, Faisil Sethi, Oliver Dale, Clive Stanton, Rosemary Sedgwick, Monica Doran, Lucinda Shoolbred, Steve Goldsack and Rex Haigh

The purpose of this paper is to describe the evolution of the field of personality disorder since the publication of “Personality disorder: no longer a diagnosis of…

Abstract

Purpose

The purpose of this paper is to describe the evolution of the field of personality disorder since the publication of “Personality disorder: no longer a diagnosis of exclusion” in 2003.

Design/methodology/approach

A review of both the academic literature contained within relevant databases alongside manual searches of policy literature and guidance from the key stakeholders was undertaken.

Findings

The academic and policy literature concentrates on treating borderline and antisocial personality disorders. It seems unlikely that evidence will resolutely support any one treatment modality over another. Criticism has arisen that comparison between modalities misses inter and intra patient heterogeneity and the measurement of intervention has become conflated with overall service design and the need for robust care pathways. Apparent inconsistency in service availability remains, despite a wealth of evidence demonstrating the availability of cost-effective interventions and the significant inequality of social and health outcomes for this population.

Research limitations/implications

The inclusion of heterogeneous sources required pragmatic compromises in methodological rigour.

Originality/value

This paper charts the recent developments in the field with a wealth of wide-ranging evidence and robust guidance from institutions such as NICE. The policy literature has supported the findings of this evidence but current clinical practice and what patients and carers can expect from services remains at odds. This paper lays bare the disparity between what we know and what is being delivered. The authors argue for the need for greater research into current practice to inform the setting of minimum standards for the treatment of personality disorder.

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Article
Publication date: 10 April 2017

Aldo Lombardo and Rex Haigh

The purpose of this paper is to demonstrate the training value of a residential “enabling environments” (LLEE) workshop in relation to the Royal College of Psychiatrists…

Abstract

Purpose

The purpose of this paper is to demonstrate the training value of a residential “enabling environments” (LLEE) workshop in relation to the Royal College of Psychiatrists’ (RCPsych) ten specified standards, as rated by workshop participants.

Design/methodology/approach

A 34 question yes/no/na questionnaire was drawn up, derived from the ten value-based standards and criteria which need to be met for the enabling environment (EE) award by the RCPsych’s Centre for Quality Improvement (Table AI). It was administered after six residential workshops, in Italy and UK, to 99 participants. Results were analysed for each of the six workshops, and for each of the ten standards, to show the degree to which participants recognised whether the standards were met.

Findings

High rates of positive responses were recorded with little variation across the six workshops sampled. Some standards and criteria showed higher levels of positive responses, and some showed slightly higher scores for “not applicable”.

Practical implications

Experiential Living-Learning Experience (LLE) workshops provide a valid training experience for those developing or working in EEs.

Social implications

Value-based standards can only be fully understood by direct experience of them, as verbal or written explanations fail to convey the psychological impact of the experience.

Originality/value

The questionnaire and its translation is the original work of AL. RH is the founder of LLE training workshops and the EE award.

Details

Therapeutic Communities: The International Journal of Therapeutic Communities, vol. 38 no. 1
Type: Research Article
ISSN: 0964-1866

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Article
Publication date: 12 June 2017

Jan Lees, Rex Haigh and Sarah Tucker

The purpose of this paper is to highlight theoretical and clinical similarities between therapeutic communities (TCs) and group analysis (GA).

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2575

Abstract

Purpose

The purpose of this paper is to highlight theoretical and clinical similarities between therapeutic communities (TCs) and group analysis (GA).

Design/methodology/approach

Literature review shows comparison of TC and group-analytic concepts with illustrative case material.

Findings

Findings reveal many similarities between TCs and GA, but also significant divergences, particularly in practice.

Practical implications

This paper provides theoretical basis for TC practice, and highlights the need for greater theorising of TC practice.

Social implications

This paper highlights the importance of group-based treatment approaches in mental health.

Originality/value

This is the first paper to review the relevant literature and compare theory and practice in TCs and GA, highlighting their common roots in the Northfields Experiments in the Second World War.

Details

Therapeutic Communities: The International Journal of Therapeutic Communities, vol. 38 no. 2
Type: Research Article
ISSN: 0964-1866

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Article
Publication date: 1 December 2007

Rex Haigh

Abstract

Details

Mental Health Review Journal, vol. 12 no. 4
Type: Research Article
ISSN: 1361-9322

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Article
Publication date: 14 February 2011

Robin Johnson and Rex Haigh

A ‘psychologically informed environment’, or PIE, is the first of many new concepts that have spun off from the Royal College of Psychiatrists' Enabling Environments (EE…

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1197

Abstract

A ‘psychologically informed environment’, or PIE, is the first of many new concepts that have spun off from the Royal College of Psychiatrists' Enabling Environments (EE) initiative. Based on the early developments in the therapeutic community movement, and adapting these values and principle to the 21st century world of community mental health, the EE initiative attempts to identify the key features in any setting that fosters a sense of connected belonging; and suggests a process by which these principles can then be customised for specific settings. The implications for a new social psychiatry at the heart of any future public mental health and social policy are clear; and to be pursued further in the final paper in this trilogy.

Details

Mental Health and Social Inclusion, vol. 15 no. 1
Type: Research Article
ISSN: 2042-8308

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