Chapter 30: Therapeutic communities, democracy and the new recovery movement

Case Study: Jean

Jean is a young woman who has been diagnosed with borderline personality disorder for over 10 years since her late teens. She feels her needs have not been met by mainstream mental health services, and has had numerous unsatisfactory admissions to acute mental health wards. She has self-harmed since she was 12 and has made a handful of suicide attempts over the years. Jean has recently been participating in the social media exchanges of Personality Disorder in the Bin. Being able to be part of a collective criticism of services and gain mutual support in the virtual world has been really valuable for Jean, and is a contrast to most of her relationships in the real world, where family and friendships have been fraught with tension and conflict. In a private message with a member of the network, Jean revealed some of her regrets about spoilt relationships and feeling she had wasted a lot of her opportunities. The person who she was messaging told her how a lengthy stay in a therapeutic community had turned her life around, and suggested that Jean gave some thought to this option.

Jean was intrigued, but did not really know much about TCs or even if such things exist in her area. If you were Jean’s CPN, how would you assist if she asks you about the possibility of joining a TC?

› Possible answer

You could spend more time talking and listening to Jean’s wishes and expectations. Once you have worked out that Jean is fully committed to the idea, you need to be able to signpost her to an appropriate facility. You also might need to advocate for her with the care team to get support for a referral. Similarly, there may be issues in securing funding that the team will have to support.