The therapeutic community inpatient ward: Does it really work?

Abstract

This study compared ward atmosphere, member satisfaction, and treatment effectiveness on community-oriented and medical model psychiatric inpatient wards. The method used for comparison was the Community Oriented Program Environment Scale (COPES) developed by Moos. The results showed that the community-oriented ward has greater patient autonomy, interpersonal involvement, and practical orientation than the medical model ward, whereas the medical model ward shows more order and organization. These results suggest that a community orientation sacrifices the appearance of an orderly ward for increased patient activity and involvement. In addition, the members of the community-oriented ward showed significantly greater satisfaction than the members of the medical model ward, suggesting that the community approach is more effective at creating a helpful level of morale and confidence in the treatment approach. A check of hospital records revealed that neurotics treated on the community-oriented ward were readmitted twice as frequently as neurotics on the medical model ward. Also, character disorder patients left the hospital against medical advice more frequently on the community-oriented ward.