A systematic review of therapeutic community treatment for people with personality disorders and mentally disordered offenders


This systematic literature review was commissioned to look at therapeutic communities in psychiatric and other settings, particularly for people with personality disorder. A therapeutic community is 'a consciously-designed social environment and programme within a residential or day unit in which the social and group process is harnessed with therapeutic intent. In the therapeutic community the community is the primary therapeutic instrument'.


This systematic international literature review has led us to conclude that therapeutic communities have not produced the amount or quality of research literature that we might have expected, given the length of time they have been in existence, and the quality of staff we know exists and has existed in therapeutic communities. This may be partly due to a lack of emphasis placed on research in the early days of therapeutic community development, and more recently to a lack of resources, in terms of finance, staff and adequate research methodologies, designs and instruments. However, it is clear that since the meta-analysis indicates that existing research is in favour of therapeutic communities, there should be more, and more good quality, and comparative, research on therapeutic communities, in order to confirm the case that therapeutic communities are effective, especially since they are expensive. In addition there is clinical evidence that therapeutic communities produce changes in people's mental health and functioning, but this needs to be further complemented by good quality qualitative and quantitative research studies.

Conducted by: CRD and the School of Sociology and Social Policy, University of Nottingham


NHS Centre for Reviews and Dissemination. Therapeutic community effectiveness: a systematic international review of therapeutic community treatment for people with personality disorders and mentally disordered offenders. CRD Report 17. York: University of York. 1999


Commissioned by the High Security Psychiatric Services Commissioning Board