Authors
1 Professor and HOD of Psychiatric Nursing, Dharwad Institute of Mental Health and Neurosciences, Dharwad, Karnataka, India
2 Department of Psychiatry, AIIMS, Rishikesh, Uttarakhand, India
Abstract
BACKGROUND: The therapeutic environment is commonly acknowledged as a significant influence
on mental inpatient treatment experiences and outcomes. Therapeutic milieu interventions provide a
distinct, secure hospital ward/unit atmosphere where patients with mental illness receive therapeutic
interactions and collaborative attentiveness. The review aimed to explore the studies related to the
role of a nurse using therapeutic milieu/milieu therapy in a psychiatric setting.
MATERIALS AND METHODS: A systematic literature search was conducted between 1976 and 2021
using PsycINFO, Medline, Embase, and Scopus. A total of 13 papers were identified for a full review.
RESULTS: A total of 70 studies were found, out of which 13 of them were analyzed. These studies
looked at several therapeutic milieu concepts, such as therapeutic communication, patient satisfaction,
nurse involvement, ward design and structure, and a mixture of therapeutic milieu concepts. Most
of the studies explored the concepts of milieu therapy in community settings.
CONCLUSION: In the mental health nursing literature, the milieu, as well as milieu therapy, is a
well‑debated subject. Though the importance of therapeutic milieu in psychiatric settings is recognized,
empirical studies on milieu implementation are scarce. Therefore, research is needed to explore the
effectiveness of milieu therapy in inpatient psychiatric care, which facilitates patient recovery, safety,
and good interpersonal relationships.
Keywords
Standards of Practice. Maryland, USA: American Nurses
Association; 2012.
2. Meehan TC. Careful nursing: A model for contemporary nursing
practice. J Adv Nurs 2003;44:99‑107.
3. LeCuyer EA. Milieu therapy for short stay units: A transformed
practice theory. Arch Psychiatr Nurs 1992;6:108‑16.
4. Hoffman L. An historical overview of milieu therapy. In: The
Evaluation and Care of Severely Disturbed Children and their
Families. Netherlands: Springer; 1982. p.1‑8. Available from: https://
link.springer.com/chapter/10.1007/978‑94‑011‑6299‑9_1. [Last
accessed on 2021 Apr 03].
5. Gunderson JG. Defining the therapeutic processes in psychiatric
milieus. Psychiatry 1978;41:327‑35.
6. Baldessarini RJ. The impact of psychopharmacology on
contemporary psychiatry. Can J Psychiatry 2014; 59:401‑5.
7. Bhat S, Rentala S, Nanjegowda RB, Chellappan XB. Effectiveness
of Milieu Therapy in reducing conflicts and containment
rates among schizophrenia patients. Invest Educ Enferm
2020;38:eo6. [doi: 10.17533/udea.iee.v38n1e06].
8. Kane C, Brackley M, Clement J, D’Antonio P, Haber J, Hamera E,
et al. Essential psychiatric, mental health and substance use
competencies for the registered nurse. Arch Psychiatr Nurs
2012;26:80‑110.
9. Kane CF. The 2014 scope and standards of practice for psychiatric
mental health nursing: Key updates. Online J Issues Nurs 2015;
20:1.
10. Let the Healing Begin: Therapeutic Milieu as an Adjunct to
Pharmacological Treatment in Psychiatry | JPMS Medical Blogs.
Available from: https://blogs.jpmsonline.com/2016/10/27/letthe-healing-begin-therapeutic-milieu‑as‑an‑adjunct‑to‑pharmaco
logical‑treatment‑in‑psychiatry/. [Last accessed on 2020 May 15].
11. Ergun G, Isik I, Dikec G. Roles of psychiatry nurses within a
therapeutic environment of psychiatry clinics in Turkey. Arch
Psychiatr Nurs 2017;31:248‑55.
12. The Therapeutic Milieu and the Older Depressed Patient.
PubMed – NCBI. Available from: https://www.ncbi.nlm.nih.
gov/pubmed/1270766. [Last accessed on 2020 May 15]
13. Caesar LG, Manty J. The Importance of a Psychiatric Milieu in Inpatient Settings (Doctor of Philosophy Project).Minnesota, USA;
Capella University: April 2015.retrieved from https://sigma.
nursingrepository.org/handle/10755/550535.
14. Walker M. Principles of a therapeutic milieu: An overview.
Perspect Psychiatr Care 1994;30:5‑8.
15. Thomas S, Bhattacharya C. Study to assess the level of satisfaction
of the patients regarding new milieu therapy provided by the
health team in a selected psychiatric hospital at Mangalore. Int J
Nurs Educ 2013;5:198.
16. Thomas SP, Shattell M, Martin T. What’s therapeutic about the
therapeutic milieu? Arch Psychiatr Nurs 2002;16:99‑107.
17. Lowe T. Characteristics of effective nursing interventions in the
management of challenging behaviour. J Adv Nurs 1992;17:1226‑32.
18. Armiyadi M. Milieu Therapy How to Implement it in Aceh
Mental Hospital (Masters’ Thesis). Innlandet, Norway:
Høgskolen I Hedmark; 2012. https://brage.inn.no/inn‑xmlui/
handle/11250/132574. [Last accessed on 2021 Mar 29].
19. Beyene LS, Severinsson E, Hansen BS, Rørtveit K. Patients’
experiences of participating actively in shared decision‑making
in mental care. J Patient Exp 2019;6:311‑7.
20. ThibeaultCA, TrudeauK, d’entremont M, BrownT. Understanding
the Milieu experiences of patients on an acute inpatient psychiatric
unit. Arch Psychiatr Nurs 2010;24:216‑26.
21. Smith Y, Spitzmueller MC. Worker perspectives on contemporary
milieu therapy: A cross‑site ethnographic study. Soc Work Res
2016; 40:105‑16.
22. Oeye C, Bjelland AK, Skorpen A, Anderssen N. User participation
when using milieu therapy in a psychiatric hospital in Norway:
A mission impossible? Nurs Inq 2009;16:287‑96.
23. Friis S. Characteristics of a good ward atmosphere. Acta Psychiatr
Scand 1986;74:469‑73.
24. Belsiyal Chellappan X, Rentala S, Das A. Effectiveness of
therapeutic milieu intervention on inpatients with depressive
disorder: A feasibility study from North India. Perspect Psychiatr
Care. 2021 Oct; 57(4):1604‑1615. Available from: https://
onlinelibrary.wiley.com/doi/10.1111/ppc. 12725. [Last accessed
on 2021 Aug 07].
25. Cardell R, Pitula CR. Suicidal inpatients’ perceptions of
therapeutic and nontherapeutic aspects of constant observation.
Psychiatr Serv 1999;50:1066‑70.
26. Delaney KR. Calming an escalated psychiatric milieu. J Child
Adolesc Psychiatr Nurs 1994;7:5‑13.
27. Bowers L. Safewards: A new model of conflict and containment on
psychiatric wards. J Psychiatr Ment Health Nurs 2014;21:499‑508.
28. VoogtLA, NugterA, van AchterbergT, GoossensPJ. Development
of the psychiatric nursing intervention providing structure:
An international Delphi study. J Am Psychiatr Nurses Assoc
2016;22:100‑11.
29. Hanrahan N, Kumar A, Aiken L. Adverse events associated with
organisational factors of general hospital inpatient psychiatric
care environments. Psychiatr Serv 2010;61:569.
30. Sedghy Z, Yoosefi N, Navidian A. The effect of motivational
interviewing‑based training on the rate of using mental health
services and intensity of suicidal ideation in individuals with
suicide attempt admitted to the emergency department. J Educ
Health Promot 2020;9:247.
31. Omranifard V, Yari A, Kheirabadi GR, Rafizadeh M, Maracy MR,
Sadri S. Effect of needs‑assessment‑based psychoeducation for
families of patients with schizophrenia on quality of life of patients
and their families: A controlled study. J Educ Health Promot
2014;3:125.
)