About Therapeutic Communities. This topic is suggested to me by a news case dealt with by the show Who has seen it, not the first in a series of disappearances from psychiatric reception and rehabilitation facilities. Certainly these are situations at risk, due to the mental characteristics of those who are guests of these structures, yet it is necessary to reflect on what the expectations of the population about these communities are, and if they are well placed.
First of all, a structure in which therapy is carried out, or which makes it possible to carry out a therapy, should be called therapeutic. Personally I am convinced of the need for structures that are not in a hurry to discharge patients (as hospitals are obliged to do) and in which it is possible with due gradualness and tranquility to subject guests to both curative and rehabilitative interventions.
At one time, psychiatric hospitals, also called asylums, performed part of these functions, even if they were other times and the treatments were less varied and effective.
The term asylum indicates a structure that houses people with uncontainable behaviors, such as “manias”, ie the excited phases of bipolar disorders, or psychosis in general, in which contact with reality is lost and the person is delirious. In more recent times, but by now the asylums were closed, the epidemic was added first, then an endemic of psychotic states and agitation related to drug addiction and drug intoxication.
Thus, initially divided by type of patient, the Recovery Communities for drug addicts and the psychiatric ones destined to manage “chronic” cases were born. In this system, there is still a lack of a network of structures capable of satisfying emergencies, with immediate hospitalizations, and also the need for protracted hospitalizations. In this void, structures that have often been called “therapeutic” have sprung up and perhaps disappeared, but which in reality simply implemented their own philosophy of intervention and treatment of sick people.
Unfortunately, there is no correspondence between the popularity of these Structures, and the support and integration they have from the institutions, and the scientific and health quality of what they offer. Some of these are frankly anti-therapeutic, rather than therapeutic, that is, they promote, in theory and in fact, practices that do not affect the progress of diseases, deceive definitive healings, penalize those who are unable to adapt to their method, and perhaps make some accidents even more likely than they would be in nature.
There are not a few cases of missing subjects, or overdosing after escaping from structures that, beyond other considerations, did not practice any specific medical-psychiatric intervention, but instead advocated “courses”, “integrated therapies”, “re-education “. Some of these structures welcome, and theorize, the removal of medicines as a necessary phase for the recovery process, or measure the “resolved” cases in terms of the quantity of medicines that have been able to suspend.
The requirements that these facilities must meet in order to be accredited (and therefore also financed or reimbursed) by the health system are arbitrary. We do not argue that they may be safety requirements, habitability and so on, but certainly there is no scientific criterion at least of exclusion. It would not be explained otherwise why there are communities for drug addicts who do not admit people to methadone therapy, which even aim at the suspension of methadone, or which require the suspension of methadone as a prerequisite for rehabilitating the person. That is exactly the opposite of good medical practice, since methadone and rehabilitation therapy favors other rehabilitation, protects against overdose and infections, as well as curing the addiction itself.
There are also, inexplicably without any intervention, Communities which are the expression of sectarian organizations, or which define a religious ideology as therapeutic.
A first handbook for those who want to choose a community can be the following:

  • the qualification on paper is entirely indicative, since sometimes, playing on the requirements, one finds structures that on the one hand declare themselves ready to accept serious psychiatric patients, and on the other put attempted suicide, aggression among the conditions of exclusion , severe depression, acute psychiatric crises … all that means “severe psychiatric patient”.
  • Psychiatric therapy includes some medications, “physical” interventions such as TEC therapy, and some psychotherapies. These methods are monitored. There are no other methods that allow themselves to be subjected to control, the “alternative” method or strangely not followed by the institutions, nor by the scientific community, is highly suspect.
  • The costs required for medical therapy are not high, so there is currently no justification (beyond the hotel characteristics) to charge tens of thousands of euros for psychiatric treatment, much less if presented as “definitely” decisive.
  • Opioid drug addiction therapies (the most common ones) are medical therapies with the addition or not of other interventions, which are often practicable even on an outpatient basis. Medical therapies are the main rehabilitation tools, so rehabilitation that avoids, or opposes, medical therapies (with agonist drugs such as methadone, typically) is absolutely scientifically groundless.
  • Other addicts may have cures still in the making, or less standardized, but the same principle as above applies. Data on the effectiveness of treatments are public. To assume that, where there is no cure, the Community is inherently therapeutic and an unfounded expectation.
  • The Community functions as an environment that makes treatment possible. The treatments are often the same that some patients are able to practice at home, but that for others require a protected, or closed, or supervised environment.
  • An ASL must be able to indicate suitable structures for the case, and not simply a series of structures that do not have any requirements to manage psychiatric and / or drug addiction cases with their therapies to be adjusted and continued during the stay.
  • There is no reason that family members are excluded from contact with the person, that contacts are not allowed, that family members are kept in the dark about the type of therapy practiced, unless the patient expresses this will in writing (in which case seems strange that he does not communicate it verbally in person to the family members themselves).
  • A structure that cannot physically “contain” the patient should be located within a para-hospital complex, or in any case in an area where the leaks can be easily stopped. There are various methods of ensuring this. Contact with hospitals and emergency response facilities must be guaranteed. Structures that by their ideology declare themselves opposed to psychiatric interventions, drug administration or something similar expose without reason to health dangers, psychiatric and otherwise.
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