Nidotherapy: The expansion of environmental treatment

The Debate article by Golembiewski (2015) was a welcome reminder of the need to put people with mental disorders at the forefront of our thinking about care. We are living in an increasingly risk-averse world in which the alleged needs of society always seem to trump what the people we are trying to help really want. We agree with Golembiewski that psychiatric hospital settings are far too often perceived as coercive, paternalistic or bland, and not nearly enough notice is taken of the subtlety of people’s experience of hospital environments in attempting to redesign them. One of the consequences of this is increasing alienation of patients in mental hospital wards and an increase in violence (National Institute for Health and Care Excellence, 2015), even though we have clear evidence that when we use hospital space more wisely and take notice of the environment there is less conflict (Putkonen et al., 2013).

Much greater attention also needs to be paid to aspects of environment beyond the hospital setting. In the treatment known as nidotherapy, attention is primarily focused on getting a better fit between person and setting by changing the physical, social or personal environment with the full collaboration of the patient. This has already been shown to be acceptable to patients (Spencer et al., 2010), to lead to better community placements and improved social function of the most severely mentally ill (Ranger et al., 2009) and lead to lesser coercion. For a large number of people who remain unwell or in uneasy equilibrium between partial symptomatic relief and adverse treatment effects, the environmental changes suggested by Golembiewski could be enhanced by nidotherapy after the patient leaves the hospital environment. It is also a treatment involving relatively low resources and as a consequence is likely to be cost-effective (Ranger et al., 2009).

See Debate by Golembiewski 49(3): 203–206.