Abstract
In the 1300s, the village of Geel in Flanders used to welcome ‘mentally afflicted pilgrims’ and supported them to work on the land, saving them from early death as outcasts from society; in the 1790s, William Tuke founded The Retreat in York and started the ‘Moral Treatment’ movement, in which people with mental illness were no longer chained up and kept as animals. In the Second World War, the group therapy experiments with battle-shocked soldiers brought the name ‘therapeutic communities’ into psychiatric practice. All these endeavours challenged the established exercise of power and the traditional nature of relationships.
This paper will explain what therapeutic communities are standing up for and challenging in contemporary times: why they are still at the radical edge of psychiatry and mental health services – and need to be. It will cover themes including the politics of data and evidence; biomedical and pharmaceutical dominance; fluid hierarchies; immersive training experiences; how patient safety can become a health hazard; taking control of quality; and toxic environments.

Rex Haigh studied social sciences as well as medicine as an undergraduate, being particularly interested in critical theories of psychiatry. After working as a GP, he trained as psychiatrist, then as an NHS medical psychotherapist and group analyst – and became a consultant in Berkshire in 1994, where he has been based since.  He received a mid-career award from the Health Foundation in 2002, and became Clinical Advisor to the English Personality Disorder Development Programme until it closed in 2011. At the Royal College of Psychiatrists, he was the founder of ‘Community of Communities’ quality network in 2002 and the ‘Enabling Environments’ award in 2008. He was on the NICE guideline development group for Borderline Personality Disorder, and is involved with several third sector organisations in the Personality Disorder field. His particular clinical interests are modified therapeutic communities, ecotherapy, critical psychiatry, and service user partnership. The social enterprise he chairs, ‘Growing Better Lives’ won the 2014 sustainability award from the Royal College of Psychiatrists. He was appointed as Honorary Professor of Therapeutic Environments and Relational Health at Nottingham University’s School of Sociology and Social Policy in 2015.