Milieu therapy is an increasingly popular approach to the treatment of psychiatric patients and a model of general application. It places emphasis on social and group interaction, on the sharing of responsibility and decision-making, on the freeing of communication on both vertical and horizontal planes and on dealing with the realities of the here-and-now. Its introduction has been accompanied by considerable enthusiasm and a sense of ‘rightness’ which parallel the existence of comparable movements in society as a whole. Partly because of this fervour, and mainly because of the methodological problems involved, intensive scientific evaluation of this mode of therapy has been difficult, though necessary. This paper describes the beginnings of a number of ongoing multidisciplinary studies, conducted on six wards in three institutions - the purpose being to provide a definition of milieu therapy, to describe its methods and objectives and to establish means of evaluation. The broad areas of the research project are: a statistical review of patients discharged before and following the adoption of milieu therapy; an in-depth analysis of the structure and functions of each of the units in the research setting; and a comparative study of the process and thera. peutic results of the six wards including two wards of other collaborating hospitals. Several constituent pilot projects have been reviewed. The advantages of an ongoing inhospital research consortium are discussed, and it is suggested that every sizeable unit should have one in the interests of the assessment of service. All that may be required is the mobilization of already existing personnel and volunteers, summer students and petty funds.
Some Approaches to the Evaluation of Milieu Therapy
