Q. How important are community meetings or ward government meetings to an inpatient psychiatric program? Are there any JCAHO standards that address the necessity for community meetings or ward government meetings in the therapeutic milieu's?

A. My personal view is that small, well-run community meetings are an important therapeutic component of an inpatient psychiatric service--leaving aside, for the moment, the issue of whether such meetings are legally or professionally mandated.

Such groups have been a part of the inpatient milieu since the 1950s. They originated in the concept of "therapeutic communities", first described by Maxwell Jones (1953). A good review of the history of such groups is found in the article by Swenson & Munich (Psychiatry. 1989 Nov;52(4):437-45). These authors point out that in very large community meetings, it is often difficult to accomplish much therapeutic work.

With respect to ward government, far less seems to have been published on this topic. In my own residency training, inpatients and staff would regularly hold community meetings, and there were limited areas in which the patients could make decisions affecting the unit as a whole; for example, issues relating to field trips, music on the ward, etc.

Clearly, issues directly affecting the medical care of patients were not part of the group's purview. I don't know if JCAHO specifically mandates community meetings or ward government for psychiatric inpatient units, but I doubt it. My exploration of the JCAHO website did not find such specific language in their regulations governing inpatient psychiatric treatment.

JCAHO does say, more generally, "Clients are involved in decisions about their care, treatment, and services..." and adds that "...clients have a right to access protective and advocacy services." [see http://www.jcaho.org/accredited+ organizations/behavioral+health+care/ standards/new+standards/ri_bhc.pdf]. If you want to pursue the JCAHO regulations, you can contact Maureen Connors Potter, executive director for the Disease-Specific Care Certification program, at potterm@jcaho.org <mailto:potterm@jcaho.org or (630) 792-5256. Or, try calling (630) 792-3003 for more information about the Behavioral Health Care Accreditation Program.

Another source of information on this issue is the National Alliance for the Mentally Ill (NAMI; 800-950-NAMI).

November 2003

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