Connection and Memory: Inside the Therapeutic Community Elders Network
Transcript of conversation with Tom Harrison, Sarah Paget, Vicky (Victoria), and David Kennard published 15 April 2026
Transcript prepared by JAS Virtual Services.
You can watch this conversation here or listen here.
We are meeting today to talk about two things, one of which leads into the other. Firstly, the TC Therapeutic Community Elders and then the PETT, that’s P-E-T-T, the PETT archive, which had been housed in Toddington, Gloucestershire. First though, can we have a brief round of introductions? If we just quickly go around, starting with you, Tom.
Tom Harrison (01:29)
I’m Tom Harrison, I was a psychiatrist and I worked in the therapeutic community in the 1970s. I’m now a historian for therapeutic communities and psychiatrists.
David Jones (01:40)
Thank you, Sarah.
Sarah Paget (01:42)
Okay, hi, I’m Sarah Paget I’m a director at the Mulberry Bush and I have the honour and privilege of supporting the Elders to come together and to help coordinate all of our activities.
David Jones (01:56)
Thank you, Vicky or Victoria.
Vicky (02:00)
You can call me either Vicky or Victoria. And I used to work at The Retreat. That was the first therapeutic community I worked in at the Acorn program for many years, starting early, I know, at the end of the last century. And then I worked managing the therapeutic community at HMP Send in the criminal justice system, which was the only therapeutic community for women at the time, I mean possibly still is, I don’t know. And yes I’m one of the TC Elders now, gosh heavens. And that’s me and I’m really an old artist as well, I should just say that. David Kennard, what about you? Do you want to introduce yourself?
David Kennard (02:39)
Hello, yes, I’m David Kennard. I’ve got various connections with the therapeutic community world. I first joined it, my first job as a clinical psychologist in Littlemore at Phoenix Unit where I met David Jones too, and got involved with the development of the Association of Therapeutic Communities there. And through that link I got involved in writing about them and wrote an introduction to therapeutic communities and I was then editor of the therapeutic community journal for some time. I left Littlemore, went to work at Rampton which was a crazy thing to do for quite a while and then went to The Retreat where I met Vicky and it turns out I also met Naomi because I did some staff support groups at Stockton Hall which is where she was working so I kind of veered in various directions connecting with therapy communities.
David Jones (03:30)
Thank you. I’m David Jones and Naomi.
Dr Naomi Murphy (03:34)
Yeah, I’m Naomi Murphy. Glad to have you all with us today. It’s really nice to meet those of you who I have not met before. I wonder if one of you could explain to us what the Therapeutic Community Elders are. I don’t know if there’s somebody who naturally could take that question.
Sarah Paget (03:51)
I could start it off, so the idea was born sort of in 2020, around that time. I think John Turberville, who is the CEO of the Mulberry Bush, but also the chair of communities at the Royal College of Psychiatrists and involved in the therapeutic community more widely, was sort of struck by the number of people who were retiring at the time and about that, the wisdom that was sort of leaving the therapeutic community spectrum at that time and thinking really about, and came across the global Elders, which is something sort of set up by Nelson Mandela and Barack Obama and others as an idea of how people who’ve been in leadership roles, senior leadership roles might help to kind of think about the future and hold something of their experience and bring that to that. So I think that’s where the idea was born and then the TC Elders just sort of got together at the Mulberry Bush third space and that then will be over to you Vicky. I think you were probably involved sort of early on or Tom was earlier.
Vicky (05:05)
Yeah I retired in 2021, so I think I was invited to join when I was early retired. And so I wasn’t in right from the very beginning. But I know I invited Tom to join. So I was obviously part of it before Tom. And I think David predates me. Anyway, David Jones, that is. In the early days, my memories of the early days when I joined was endless, endless discussions about how difficult it was to be called a TC Elder and how being compared to such people as Kofi Annan and Nelson Mandela was somewhat cringe making. And we really wanted to be called something else like the old fossils or something. But anyway, yeah.
However, we have sort of developed and a little bit and new things have happened and we have a monthly Zoom with people working in therapeutic communities or want to know more about making their practice more therapeutic community minded in some way now, so that’s really a super sort of connection to the here and now and makes us feel less like old fossils, I think. And also one of the things I’ve done and we’ve been thinking about developing, maybe talk a bit more about when we’re talking about the archive is a kind of living archive aspect of the TC Elders. And I have an aid, sort of show and tell aid that I can demonstrate, which is an alphabet. There’s letter A, you can see letter A right beside me, but we want to do an online kind of way of developing therapeutic ideas and making it a real living thing that people out there can contribute to in here and now. So I’m very, very interested in that aspect of what we’re doing. But David and Tom will have different perspectives on that as well. So quite like to their ideas about the TC Elders.
David Kennard (07:03)
For me, it’s sort of quite simple. It’s a way for retired Tate Bridge community people to stay in touch with each other, which is quite nice. I mean, like the people on this call here, people I wouldn’t otherwise be in regular contact with. And it’s a way of keeping in touch with the struggles that people now who work in various kinds of settings, not just say, communities, but it’s actually where they want to use, say, community ideas, keeping in touch with what they’re doing through this Zoom call that we’ll probably talk about a bit more. And where we can, offering ideas that we hope will be helpful to the difficulties that they might be facing.
Tom Harrison (07:51)
Yes, I think the Zoom call for me has become the most important thing of what we’re doing in the sense that it’s very evident that people really value it. I mean, they come from America, they come from India, they come from Sweden. And these people have really told us how much they value the connections that we give them. And I think I’m also extremely excited by the idea of the ABC that Vic is talking about. I think this is a way of collecting material that perhaps otherwise will be lost in its, I can’t think of the right word, but it’s convenient, it’s not the right word, but it’s happening when the PETT Archive is closing. It perhaps makes up a little bit for that tragedy.
Sarah Paget (08:43)
If I was just to add something to everything that everyone said is that I think that in many ways the Elders provides a space where people who are working with very difficult people and in very difficult circumstances can find a space to think. And one of the things we’ve talked about is the idea that negative capability, the idea that people can sit with not knowing is becoming very rare within the public sector and within life generally. And I think what the Elders provide is a space to feel okay about not having all of the answers and a space to just think together and that something might emerge. So for me, that’s the most poignant message and what we role model more than what we say, I suppose.
David Kennard (09:34)
As a TC Elder yourself, are you going to contribute your view or just leave it or not?
David Jones (09:40)
I wasn’t going to say very much, no, but I am thinking while you’re talking about the group, because it is in effect not just a Zoom group of which there is a proliferation, but an online community meeting which provides exactly the opportunities that you’ve been talking about.
Sarah Paget (09:58)
Yeah.
Dr Naomi Murphy (10:03)
So sounds like Elder is exactly the right word for what you’re doing in the sense of all having had extensive experience within the therapeutic community world and wishing to share your knowledge and experience and offer that up for people to be able to draw on for guidance, advice, mentorship maybe, am I picking up from there? And how would somebody access this as a resource?
Sarah Paget (10:27)
Well we have a presence online, so at the moment we have a presence on the Mulberry Bush website, the Mulberry Bush hosts the Elders, but we’re looking to broaden that out and for the artwork that’s being described being sort based within a journal setting and that people would be able to access through that, so it’ll be online and directly through our email address.
David Kennard (10:57)
An email invitation goes quite widely to various groups for each Zoom session. And I’ve sometimes been surprised at the people who join us. I think, yeah, it does get quite a wide distribution, the invitations to the Zoom sessions. We call them the open forums.
Dr Naomi Murphy (11:15)
How many people tend to join those forums?
Tom Harrison (11:18)
There is between maybe 6 to about 12. A lot more people sign up for the forums, but they don’t, obviously due to difficulties of trying to attend that I’ve demonstrated today, affect people who come.
Dr Naomi Murphy (11:34)
And do people pay a membership or do they just have to have an interest in it and it’s a very generous service to be offered up?
Sarah Paget (11:43)
Yes, there’s no fee, is in a sense what the Elders are offering to communities in the present, to be able to, as you say, mentorship. I think that’s a really useful word for much of what we do.
Tom Harrison (11:43)
Yeah, that’s interesting.
Dr Naomi Murphy (11:57)
A really lovely offering. I suppose I was thinking even beyond therapeutic communities, there are large group meetings that happen in all sorts of places which people might not recognise as being a therapeutic community origin, but actually maybe there are other people beyond the traditional therapeutic community setting that might benefit from what you’re offering up to people. So are the people running services within the prison service for instance, who might not be in a TC, it sounds like they could get some benefits from the knowledge that you’re sharing in these forums.
Vicky (12:30)
Well, I think it’s not just us sharing the knowledge. In fact, I’m sure I learn as much as anybody on those meetings because there’s an international group of people who talk about, what is it like in Portugal to be working in a public service, trying to work therapeutically, or what’s it like in Sweden or whatever. So there’s a lot to share from the members of the group. And I would encourage anybody who’s interested to join that group because it is free. It is what you make it. And it’s lovely to be with like-minded people. And with everything going on in the world, it’s a way of helping one another cope with all the modern world and the challenges of working in a relational way in a modern world that’s so fragmented, that fragments relationships and where there’s so much that’s anti-therapeutic that being banded about. So yeah, it’s a good thing to join. And I don’t think most of us would want to be part of something like that, that people could only join if they were in a privileged position and could pay for it. I don’t think.
David Kennard (13:39)
And it’s at a fixed time. It’s the same Thursday of the month, the third Thursday of the month, two to three. So we only more recently made it like that so that it becomes a kind of very predictable event that people can relate to. And I think there’s something quite important about it being predictable like that, given what Vicky was saying.
Sarah Paget (14:02)
I do think it provides an anchor for people. I’ve had emails from people who say that they’re comforted by the very thought that it’s happening even when they can’t come. So I think it does provide something of a safe space and you know it really isn’t a group of Elders telling people or giving advice or anything of that nature. It is genuinely a space that’s held by the Elders, many of whom aren’t here actually, so we have got other Elders that are not present with us, think it’s worth noting.
Dr Naomi Murphy (14:31)
I will follow up on that in a moment Sarah, I suppose I was just thinking as you were talking I was reminded of recently watching, is it Cory Doctorow talking to Aaron Bastani about enshitification and about how everything has become so monopolised with the idea, taken over with the idea of making money and fragmented as a consequence of that and it seems to me that you guys are trying to do the exact opposite of that, of offering something that’s very community focused that it’s about giving something back rather than taking away and just trying to strip assets out of everything. It sounds like a really beautiful project, but yeah, it’d be really great to know who does join as an Elder. So we’ve heard that it’s open to anyone who wants to come and attend and benefit and we can share the links to what you’re doing in the show notes, but it’d be really good to hear how people end up joining as an Elder.
Tom Harrison (15:26)
We spend quite a lot of time on this subject trying to think about people who we would like to join. And obviously it’s open to people who would like to join us. But we do spend a lot of time thinking about those people who are close to retirement or who have retired that we know of, and we’d like to invite, not everybody wants to because they’ve frankly had enough of therapeutic communities. It’s those of us who continued are still passionate about it.
Vicky (15:57)
I think some people have other conflicting commitments and stuff as well. I don’t think it’s just that they’re not so passionate about TC’s anyway, they can express that through various different outlets.
David Kennard (16:08)
One or two people do come onto the Zoom session to consider themselves to be Elders, although we haven’t actually invited them. There’s a certain blurring there about what constitutes an Elder, and we haven’t quite resolved if we want to clarify the boundary or leave it bit blurred.
Vicky (16:25)
I think there’s a sort of sweet spot where you’ve still got some energy and you want to give something and you can do it. It physically works for you, you know, it works out. It’s not an inconvenience. It doesn’t clash with anything else you’re doing. And you’re not so elderly that it’s actually just, you know, gets impossible, too difficult. It just has to suit you, doesn’t it? And work out. That’s how it is.
Sarah Paget (16:51)
We do have a lot of people on an Elders, you know, TC Elders distribution list who don’t actually participate. So I think it’s interesting that when you say about who can be an Elder, we have many people who subscribe to being part of something, but not everyone is contributing all of the time consistently. So there is a small group, sort of almost self-chosen group, who become those that are delivering the open meetings, the open forums and such. But I think personally that the process of actually going through this and wrestling with who is an Elder, who shouldn’t be an Elder, it’s very therapeutic community, I think at some point an answer will emerge and I trust the process really.
David Kennard (17:39)
There has been a turnover, I mean people have left the elders group.
Vicky (17:43)
Quite funny, my husband just walked out the door then, who’s another elderly gentleman, deciding he’s leaving the Elders group.
Tom Harrison (17:49)
I have to also say that as a group of people, I found the Elders to be people I trust and love and work together very comfortably with and learn lot from.
David Jones (18:00)
Can I just refer to the online group again? Because as we’re talking, I realise I’m not absolutely clear whether it’s for anybody who’s kind of involved in therapeutic work or whether it’s specifically for people who work in therapeutic communities. What would you say?
Tom Harrison (18:01)
I think people self-choose themselves. They’re interested in what lies behind the therapeutic community approach rather than necessarily all working in therapeutic communities. Certainly one person very much finds us a support system because of the environment that he’s working in feels so antagonistic to how he would like to work. On the other hand, there are people who are flirting with the idea, well, not flirting, who wish to set up a therapeutic community and have used the group to listen to the ideas. So it’s a range of people. It’s just people working in therapeutic communities. It’s about the feeling behind it, the emotional approach to people listening and hearing people.
David Kennard (19:05)
I don’t think we’ve yet faced a situation of somebody joining that we thought shouldn’t be in the room. But I suppose it could happen.
Tom Harrison (19:12)
That’s true.
Vicky (19:14)
But I can think of two people at least who come from different parts of the world. One of whom has worked in therapeutic communities and probably would be an Elder if she was in this country, but she isn’t. So she can’t join us for our in-face meetings, for example, but clearly enjoys some of the like-mindedness in the group having worked in a therapeutic way in the past. And I think that serves a perfectly good function for her and she shares things that are useful. And somebody else who works very much with trauma in communities and the aftermath of traumatic events, who’s never been a therapist and doesn’t work in a therapeutic community, but nevertheless again, there’s a like-mindedness, something really valuable about being able to think in this special TC way, even though, you know, she hasn’t ever worked in a TC and never will, but it’s still useful in thinking about the aftermath of mass casualty events. So actually, you never know how someone’s going to attach or what’s going to be relevant. But I don’t think it’s in any way an exclusive group. I think the nature of therapeutic communities is that they’re almost relevant to everybody because we’re all human.
David Jones (20:40)
So it sounds as if it’s for people who wish to think about the therapeutic work they are doing or would wish to do and who will reflect upon the feelings that are evoked in the work, which is perhaps a bit more of a general kind of definition.
Tom Harrison (21:00)
And also developing a friendship group in a sense of adversity. People working in America at the present time in this particular way feel very isolated. So it’s that sort of emotional attachment as much as anything else.
David Kennard (21:15)
I’ve been struck by people who joined who are in management roles in an organisation and struggle with the issues within the staff team and would like to be able to introduce more with therapeutic community ethos. But meanwhile, feeling perhaps rather isolated or up against it in their management role. And so we provide that support and for people like minded people who understand the issues that they are experiencing.
David Jones (21:44)
Thank you. Can I ask Vicky whether your alphabet is available online.
Vicky (21:51)
I don’t know, Sarah would know. It is available online. Sarah, can you say, I don’t know whether it’d be available right now, but I’ve got the original artwork with me right now. Is there a way of getting it online or can I just show people pictures?
David Jones (22:06)
Well, I was asking really because I think it’s a masterly work of art. It truly is a magnificent piece of work. And yet, as we know, it’s a work in progress.
Vicky (22:21)
Yes. I mean, the idea online to go back to the online thing is that people will contribute to it. So it’s just the beginning of something. And it’s to elicit responses from people. And I think the grand plan, as it were, is to issue a letter every so often in an online access, open access kind of way that people can respond to with their own it could be memories of being in therapeutic communities. I’m showing it to the person I was staying with last night who said, I used to work in a therapeutic way with a man called David Clark at Fulbourn Hospital. And I said to her, well, actually, that’s in my A to Z of therapeutic communities on C for Clark. And I showed her the page and she told me, yes, I sat at the feet of Maxwell Jones and I learned all this about nursing and I’ve used all my years nursing with young women with eating disorders. I always worked in a therapeutic community where I didn’t even know any of that. I’ve known this woman for 30 years and didn’t know any of this. So it’s to elicit these kinds of responses from people so that it isn’t in itself an end in itself.
It’s just a beginning and it’s a way of eliciting the kind of things that could be in an archive, but actually might always have been missed because they’re not grand studies or papers that have been poured over and peer reviewed. They’re just people’s cherished memories, thoughts, recollections, photographs, poems they wrote, whatever, about these kinds of ways of working, therapeutic communities and like-minded ways of working that have influenced people throughout their lives. So yeah, so just saying that and I’ll actually show you the bit. This one, this page, which I think shows up a bit, that’s B, it’s probably backwards, isn’t it? That was that was letter B. Now I’m going to show you David Clarke of Fulbourn. He’s in that corner somewhere. You might not, but this is letter C. And also on letter C is culture of inquiry and community of communities and collective and courage and Craig Fees, children, compassion, columbine, connect, cooking and eating together.
Yeah, so lots of stuff, culture of curiosity, cup of tea or coffee. So it’s about a multifarious collection of things which people can relate to and perhaps share their own recollections or that triggers something. Because this is important. And I suppose even with the archive closing, what we’re saying is the urge to create you know, an archive, which is then the means of finding evidence for doing what we do and going, yes, someone’s done this before. And one of the things I’ve been thinking about a lot is how the people who have been in therapeutic communities in the past, in a different kind of world with less regulation, which is a, you know, a mixed thing, but less regulation and developing the culture inquiry and developing the therapeutic community impulse and so on. Our inspiration for the future and this A to Z is a kind of another way of providing inspiration for the future by reminiscing on what’s gone before and sharing knowledge.
David Jones (26:11)
Well, we’ll have to find a way of getting it online, Vicky, so that people can see it, because what you did just then was throw out the whole contrast between the list of things and names that you gave us and the piece of artwork which shows how they’re all linked together in a creative mess.
Vicky (26:29)
Yeah. I just hope it sort of elicits something and that I wish to see this artwork more, which is good, because there will be a way might not be ever so easy right now, but there will be a way and it is coming in your direction. So look out for it.
Sarah Paget (26:46)
The intention is very much for it to be online and I’m working on it as we speak.
David Jones (26:53)
Excellent. So who can be an Elder? Is there a way of somebody who might view this podcast, for example, who can they email and say, I’m here, I’m interested?
Sarah Paget (27:04)
Yes, I mean, at the moment, best person to email would be me, I suppose, at spaget@mulberrybush.org.uk And then what I do is any question that would come through to me about the TC Elders, I would then pass on to the group and we would have a conversation about that and yeah, invite them for a conversation.
David Kennard (27:25)
We should say that an important aspect of the Elders is we meet in person twice a year. And if somebody wants to be an Elder, they really need to be able to access that. It’s quite an important part of keeping us together. So that’s why it would be difficult for somebody, say from another country, unless they could manage it, to join. Up to now, we have always met at the Planned Environment Therapy Trust archive. But that we have to go on tour now because it’s closing and that’s quite important thing for us.
Tom Harrison (28:06)
We may come to a place near you.
David Jones (28:09)
So, well that’s interesting David because Vicky is currently at MB3 which is at Toddington in deepest Gloucestershire I think. Is that right? Gloucestershire. And so we can now I think move on briefly to the Planned Environment Therapy archives, the PETT archives. So what is or what has been the PETT archive?
Tom Harrison (28:43)
It was set up by Craig Fees. Probably, I don’t actually know the date when it was started, but it must be the mid-80s, something like that, and to a large extent, certainly in the early years, it circulated around Craig who went out to collect archives of individuals, communities, and anything that was clearly relevant to therapeutic communities.
David Kennard (28:50)
It wasn’t just a personal project, was it? It was part of the sequence of New Barns Therapy Community closing and funds being created into this organisation called the Planned Environment Therapy Trust. Am I right?
Tom Harrison (29:24)
Yes. And he created, I mean, although it wasn’t just him, I have to say, he was sort of the pivot around which everything else has gone. He collected a huge number of archives. I didn’t know this, but I believe he even collected them off skips where people were throwing them out. I worked with the archive on my first project, which was looking at the Northfield experiments. And that’s where I met Craig back in, I think, the early 90s, 1990s, and I’ve known and worked with him ever since. Subsequently, I did my PhD on Richard Crockett and the Ingeborg Centre, which was all the material, most of material for that came from the archive, was able to collect it from other archives as well, interviews. But Craig was extraordinarily helpful in that.
David Jones (30:25)
So it’s been gathering together all kinds of information, personal papers by the sounds of it, official materials as well from a whole range of settings, including NHS settings. I don’t know what that is, Vicky.
Vicky (30:41)
The Northfield experiments. Actually there’s my drawing of Tom there lecturing about the Northfield experiment. I mean obviously it’d be much better online but I just couldn’t resist that.
David Jones (30:54)
So places like the prison service presumably as well and NHS settings. So across the whole range of therapeutic community and therapeutic community related organisations.
Sarah Paget (31:10)
Yeah.
David Kennard (31:10)
There’s about 500, is it about 500 collections, I think.
Tom Harrison (31:17)
Something like that, yeah.
Sarah Paget (31:19)
So I think the archive has had a number of changes over the years and the Planned Environment Therapy Trust came to a situation where they were unable to continue to maintain the archive and it was suggested that potentially the Mulberry Bush take over the archive and take on responsibility for enabling the archive to be more available to a wider number of people. And so I think the Mulberry Bush which took it over in 2021, something like that, 2020. And there was a view that they would spend about five years or so working out what it would take to kind of enable the archive and the study centre at at Toddington to thrive. Unfortunately, over the last couple of years, it’s proven very difficult for that to happen. The archive is an extraordinary environment that is very difficult to maintain. It’s come to the point where the Mulberry Bush had to decide that they could no longer support it and so it’s announced its closure towards the end of last year and it will close on May 31st this year.
Tom Harrison (32:54)
One of the things that struck me over the last, on reflecting all about this, which has been seen by many people as a tragedy really, is the weight of archive, a weight of memories. Literally, in the sense that paper and books are heavy and there are cracks actually in the floor of the archives. And I think that sort of signifies perhaps we didn’t realise as a therapeutic community group, the wide group, we really didn’t realise the weight that people were taking. People like Craig and the PETT organisation, and subsequently the Mulberry Bush. We actually didn’t realise the heaviness of the task. And they’ve, to a degree, I think we’ve allowed them to carry that burden without really reflecting on how much we could have contributed as a much wider group in therapeutic communities.
Dr Naomi Murphy (33:59)
The two projects that you’re involved in, so this archive and also this group of Elders, and it feels like you’re trying to preserve something that sounds, you know, maybe a therapeutic way of being that might feel quite under threat at the moment, you know, again, back to that process of intensification and the prevalence of sort of short-term interventions being what people get offered when they approach the NHS for help. And I wonder if there’s a kind of fear of all this extensive knowledge and experience being allowed to wither away and disappear in some way, rather than being able to be held onto and sustained and be treated with some kind of reverence or value.
Sarah Paget (34:44)
You know, I think that Tom’s description of the heavy book sort of breaking the floor is quite a really useful imagery for the kind of weight of responsibility that sits around the archive. And I think you’re right. I think there is something there about how the responsibility that we have for this amazing history that the archive holds. And I think it’s really important that we point out the amazing work of Deb’s Doggett and Gareth Beynon who have brought that archive back from the brink, really, and enabled people to access it over the last few years. I think with the decision that’s been made, which has been heartbreaking for everyone involved, there is still a sense that those archives can now go on and into other spaces and be used. So there’s a positive in that respect. But I think that, yeah, there is that what goes along with this is, again, the sense that therapeutic community work isn’t valued and that in order to maintain the incredible collections that are there, there is a cost associated with it that people are not prepared to pay. And I think that’s a very sad state of affairs that reflects therapeutic communities in general across the public and private sector. The therapeutic communities are very hard to find outside of the prison service, interestingly, the prison service therapeutic communities are still part of very important rehabilitation processes within prisons. But outside of that, think children’s therapeutic communities are probably the most prevalent, whereas for adults, it would be very hard push to find them. There’s some day services in Thames Valley and Kent, aside from that. So I think the therapeutic community ideas and principles are under threat and continue to be. And yet the ideas are so attractive to so many people that join our group.
Tom Harrison (36:59)
We live in a neoliberal society that promotes the individual as opposed to understanding that we depend on each other and we have responsibilities to each other and we only exist in groups, but that doesn’t fit with the economic way of looking at things which looks at basically the individual greedy person.
Vicky (37:23)
Well, I think you’re right about the neoliberal thing. Because I mean, at The Retreat, we did a cost offset study. And actually, after four years, our patients who were very, very expensive to treat 100,000 pounds for a year at The Retreat, but after four years, they were cost neutral and going forward, were cost effective, because police services and ambulance services and inpatient ordinary standard hospital admissions and so on. After four years, it was cost neutral. But I don’t think it’s about effectiveness or cost. It is about this neoliberal thing. They’re not fashionable and nobody wants to say that actually they’re jolly effective. Steve Pierce did, you know, randomised controlled trial of therapeutic communities, for goodness sake, and found that on two counts, they were actually better than treatment as usual, including patient satisfaction and the very important issue of outwardly and inwardly expressed aggression. I mean, that’s why they’re in prisons. They’re in prisons because they’re effective. Prisons actually don’t care that much about what’s fashionable. They have to exist. They carry on existing. The hotel services in the prison are paid for. So, you know, the therapeutic community, although it’s expensive, actually is a good way of rehabilitating people in an institution where they’ve got no choice but to live in an institution. So, where they work, they work really, really well. But I think, this neoliberal business and the individualism and so on is a real problem. But it’s very interesting just driving here sorry, I don’t mean to go on, but there was a lovely critique by the man on Desert Island Discs who’s a heart surgeon, who was saying that actually it’s difficult to be a heart surgeon because a lot of patients die. People, doctors don’t want to have high mortality rates anymore, all that’s measured. So it actually puts people off doing innovative things that really work for very ill people. And I think therapeutic communities have struggled for exactly the same reason. The people who they serve best are really, really struggling massively and are very risky people to treat. And nobody wants to have those, oh they might have committed suicide or something. So they’re just really not being served well.
David Jones (40:04)
Thank you, Vicky. We’ve just got a couple of minutes left. I wonder what we could say to sum up this conversation.
Tom Harrison (40:12)
I just wanted to say that these ideas go broader than in therapeutic communities. Some years ago, Sarah invited me to join a group about enabling environments. And I’m involved in a group of people in our little village here about how we can provide proper housing for local people. And that is run by a group. And I’m using the material that I’m gaining from all the people around here, how to get that group functioning so the group itself is able to contain the feelings that are going to be aroused.
Sarah Paget (40:46)
I wonder David whether you could say something that you said to me before we came on to this call about that you were talking about how therapeutic communities are common sense and in many ways and I think that would be a good way of summing it up really.
David Kennard (41:02)
Well, I just meant that the idea that, unless you’re a hermit, we live with other people and we often are engaged with doing things, working with them. And when we do that, tensions and disagreements are bound to arise. And the therapeutic community approach is to offer that as a situation that people who have really not done well in group situations can re-experience the problems but with an opportunity to reflect, to take time out from the activities that are causing problems, to reflect on what’s gone wrong, on what to try differently and then to try it out. So it’s kind of an ongoing process which makes sense because they’re using the material, the events that occur between people anyway to try and understand them and learn from them.
David Jones (41:53)
Great. Well, thank you everybody. I’m going to stop us there because we’ve run out of time and thanks very much indeed to everybody.
Dr Naomi Murphy (41:58)
Thank you.
