Mental Health Notes 1/19/2021

*CLINICAL: Pay attention to the color of walls and tiles in the unit, and what things are present on one
unit and not in another.

Milieu: French word meaning middle. Translates to surroundings or environment.

 A scientific structuring of the environment to effect behavioral changes and improve
mental health functioning.
 Within the therapeutic community setting, the client is expected to learn adaptive
coping, interaction, and relationship skills that can be generalized to other aspects of
life.
 The nurse is responsible for all aspects of milieu.
 3-5 days is usually the max amount of stay for each patient. The milieu therapy is still
used but is modified to conform to this short term care approach.

Basic Assumptions of Milieu Therapy:

1. The health of each individual is to be realized and encouraged to grow.

2. Every interaction is an opportunity for therapeutic intervention.
3. Each client owns his or her behavior.
4. Peer pressure is a useful and powerful tool.
5. Inappropriate behaviors are dealt with as they occur. People know what is acceptable and what
is not – if they do so there will be consequences for that but nothing that is detrimental.
Restraints are a last resort.
6. Restrictions and punishment are to be avoided.

Containment: safety, security, food, shelter. Very important, probably #1 with food and shelter.

Validate: affirmation of clients self esteem

Structured interaction: enables client to benefit from social interactions with each other as well as staff

Open communication: clients are encouraged to share information with the staff

Conditions that Promote Therapeutic Community:

 Basic needs fulfilled

 Treatment plan is directed by an ID team (interdisciplinary) – usually coping skills
 A democratic form of self government exists: there are rules to follow and things you can and
cannot do, things agreed upon by everyone
 A structured program of social and work related activities is scheduled as part of the treatment;
some places have rehab and a work-release program.
 Community and family are in the program of therapy in an effort to facilitate discharge from
treatment
 Responsibilities: making bed, clothing, coming to the station for meds, etc.
Role of the Nurse:

1. Manage therapeutic environment on a 24 hour basis

2. Repsonible for ensuring
3. Med administration
4. One to one relationship development
5. Setting limits on unacceptable behavior
6. Client education: See page 153, table 7-2 ***