Kan det terapeutiske samfunn forandres sa det passer bedre for pasienter og personale i dagens institus j onspsykiatri?

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Abstract
A highly group-oriented therapeutic community went into a crisis when the percentage of acute psychotic patients was increased from 30 to 60 and the mean stay was reduced from 50 to 25 days, as a result of the »lsectorization« in Oslo. The examination of the ward by WAS, Good Milieu Index, non-participant observations (a.m. Thelen, Whitaker), semi-structured interviews etc., revealed a »burnt-out syndrome« in the staff and a highly unfavourable perceived milieu by the patients. On the basis of earlier studies by the authors, it was predicted that the burnt-out syndrome would disappear and that the patients' perceived milieu would change in a favourable direction when the program was changed to a more individually oriented one through: a reduction of compulsory groups from 23 to 5 hours per week, all group activities became task groups, the milieu therapy individualized, and the number of beds reduced from 26 to 17. The ward was re-evaluated after one and two years, and the predicted changes had taken place. This shows the possibility of making a milieu more therapeutic through planned interventions in the program. It also shows that the amount and type of group exposure have an important influence on the perceived milieu.

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