Community meetings on a military inpatient psychiatric unit: A question of balance

Military Medicine, Jan 2001 by Lange, Christopher L

Community meetings are a mainstay of any inpatient psychiatric unit. Although they differ in frequency, attendance, leadership, and size, they all maintain a similar purpose of acculturating the members to the values of the ward and encouraging responsible behavior and effective communication. The military inpatient psychiatric unit is no different, although it does have several unique factors that affect the management of the community meeting. Specifically, these factors are the inherent military rank structure, which often conflicts with the rank of staff and other patients, the incorporation of a civilian population into a military culture, and a greater focus on patient transitions from military to civilian society. We describe and discuss the common variables of community meetings, elucidate how the military aspects affect the meeting, and offer potential suggestions for the management of this unique large dynamic group.

Introduction

A standard element of any inpatient psychiatric ward is the community meeting. This meeting usually includes all members of the milieu, patients and staff, in a regular effort to enhance communication, determine ward management, and augment psychiatric treatment. Surprisingly, such a pillar of the therapeutic milieu has little standardization with regard to its structure. Diversity of style and form is the north rather than the exception. This diversity is likely secondary to the differences in patient census, acuity, and social status between ward communities at different hospitals.

The military is its own society, and one could rationally assume that standardization would be a norm in its culture. However, the same differences in patient populations that are found in civilian hospitals are also seen at military medical centers. Therefore, differences in style are found from one inpatient community meeting to another.

Unique to the military inpatient psychiatric unit is the concept of a transition from the military society, to the inpatient community, to the civilian culture. This quality of the unit is influenced by the incorporation of civilians into the ward, differences in rank on the ward, and activities geared not toward reintegration but toward separation. The incorporation of these attributes is how community meetings can benefit the military psychiatric patient.

Purpose of the Community Meeting

With its roots in the old town meetings, the therapeutic community meeting was first conceived by Main at the Northfield Military Hospital in Birmingham, Alabama. Main noted that the imposed values of the staff caused the patients to regress, and he called for a "therapeutic setting with a spontaneous and emotionally structured (rather than medically dictated) organization in which all staff and patients engaged."' Jones followed this motif at Belmont and introduced his milieu with a joint meeting designed for the purpose of patient education and information relay that he labeled the "community meeting. "2

The community meeting can be viewed on any point along a spectrum between a simple component of the community and the equivalent of the therapeutic community. The patient's understanding of the purpose of the community meeting is their uncertainty regarding the utility and function of the community meeting. What is agreed upon is that the community develops a method of repairing social role functions by combining both an organizational structure and individual interactions. It provides a vehicle by which the relationships and activity of the milieu can be implemented and shown to be a microcosm of the patient's "outside world."' For lasting changes, the meeting must provide a forum for discussion and scrutinize events and behavior from an interpersonal and ego-dynamic viewpoint. This allows maximal use of group approval and disapproval as an agent of change.4

Stated simply, the community meeting is a large group therapy session. This tends to be a difficult undertaking because it combines a multitude of approaches, namely behaviorism, communalism, and functionalism. This aim leads the less ambitious to redefine the purpose of the meeting in terms of only one of the modalities. Although such splitting of these psychotherapeutic approaches is not necessarily detrimental, it should not distract from the meeting providing an unambiguous mechanism for the enculturation of patients, encouraging them to act responsibly and to demonstrate their capacity for effective functioning with other patients and staff.

Method and Form of the Community Meeting

The community meeting is a device to create a culture with common norms, attitudes, and values that are deemed therapeutic. The method by which these aims are developed can vary. Some use a directive approach to use the meeting for administrative and system maintenance functions. Others seek to perform the maintenance function and to come to "terms with community problems."6 Jones did not create a fixed format for his community meeting and revised his policy quickly after its inception. Since that time, the community meeting has taken diverse routes, forms, and names.