Democratic Therapeutic Community in a Network of “Enabling Environments†: Transformations of Psychotherapeutic Residential Services in Social Postmodern Crisis

The purpose of this article is to present a model for new democratic therapeutic community programmes for seriously ill patients, based on social networks. This model is based on the concept of the Democratic Therapeutic Community in a network of “enabling environments†, in a social context of crisis. It represents an evolution of the tradition of Supported Housing as Therapeutic Environment for people with severe and persistent mental illness, in Sicily. A postmodern transition from old Psychiatric Residential Services to new Psychotherapy Community Based. These programmes have given birth to a range of new type of democratic therapeutic community, understood as a new practices of group-psychotherapy community-focused for severe and persistent mental illness. In this article the authors propose and present three type of new DTCs: 1) Group-Apartment (GA); 2) Non-Residential Democratic Therapeutic Community (NRDTC); 3) Guest House of Psychotherapeutic Treatment of Crisis (GHPTC). This new model has been developed in Sicily as a response to the serious economic and political crisis of the last decade. It has encouraged mental health professionals to reconsider in the light of the new international interest in mental health ‘recovery’, the English democratic therapeutic community tradition, and the Italian health care policy choices that with the Law 180/1978, excludes possibility of permanent shelter in psychiatric hospitals, of users with severe mental illness. The Italian health care policy, with the Law 81/2014, definitively closed also the Judiciary Psychiatric Hospitals. So communitarian treatment of these forensic users will be totally in charge of territorial mental health services and of new TCs. Therapeutics processes of this programmes are given by creating ‘enabling environments’, through psychotherapeutic and psychosocial treatments between the house of users and the place of the therapeutic community, in which ‘communal living’ is developed as a contexts of care that identify itself as part of a broader social community of purpose and scope, that we use to define the ‘Local Community’. The ‘therapeutic communal environment’ offer suitable care to ameliorate the post-acute phases of mental illness, and play a role of intermediary between the services offered by the NHS and the social community, on one hand, and the caring work carried out by the family as a whole and the job context, on other hand. Three type of new DTCs have been developed from three programmes of “Supported Housing†, whit evidences of effectiveness in the scientific field of Mental Health Community-Based: 1) Cooperative Apartment (CA), 2) Supportive Leaving (SL) and 3) Crisis Resolution and Home Treatment Team (CRHTT).