20 - Nidotherapy: making the environment do the therapeutic work

Summary

Summary Nidotherapy is the formal term introduced to describe the systematic manipulation of the physical and social environment to help achieve a better fit for a person with a persistent or permanent mental disorder. This approach is described in detail and its merits are compared with more conventional ways of dealing with such problems. This involves the creation of a certain number of terms that may be viewed as unnecessary jargon but help to shorten communication in an area where systematic monitored interventions are relatively uncommon.

Nidotherapy (the ‘i’ is long) has come about from the frustrations of exercising evidence-based treatment options with a minority of patients who despise them all with equal fervour. It is a treatment that systematically adjusts the environment to suit the needs of a person with a chronic mental illness, personality disorder or similar long-term disability. The name is derived from the Latin nidus, or nest, as a nest, particularly a bird's nest, represents one of the best natural examples of an environment adjusted to an organism (Tyrer, 2002). Although taking the environment into account is part and parcel of clinical management, the systematic manipulation of the environment, often in a subtle way to include both physical and social environments, has not been formalised before. Many reading this chapter will regard such action as the exercise of common sense rather than any special type of intervention and will be sceptical about formalising it under a fancy title such as nidotherapy. They may be right, but we would like all to suspend judgement until they have further evidence of the value of this approach expressed in a more formalised manner.

Principles of nidotherapy

There are five essential principles of nidotherapy: collateral collocation; the formulation of realistic environmental targets; the improvement of social function; personal adaptation and control; and wider environmental integration involving arbitrage (Tyrer et al, 2003a) (Box 20.1). These need amplification.

Box 20.1 Principles of nidotherapy

Collateral collocation

Seeing the environment from the patient's point of view

Formulation of realistic environmental targets

Setting clear goals for environmental change

Improvement of social function

If the targets are right, social function will improve; if it does not improve, the targets need to be reassessed

Personal adaptation and control

Throughout nidotherapy the patient takes prime responsibility for the programme