Normalizing & Domestic Settings
As in moral management, treating people with respect in normalizing and domestic settings leads them to exercise “moral restraint,” or self-control over their impulses. In someone’s home, one feels obliged to treat other people and property with consideration, but in an institution, anything goes. This observation allows us to understand why it is possible to care for compulsorily detained patients in open-door, domestic settings. If the alternative setting is more attractive to the patient than a hospital unit, then he or she is likely to call upon reserves of self-control in order to be allowed stay there rather than in hospital. Cedar House (recently renamed Warner House), a 15-bed hospital alternative that has been in operation for 30 years in the public mental health system in Boulder, Colorado, has found that the facility can accommodate at least half of the catchment-area patients in need of acute inpatient care at any point in time, including many patients requiring compulsory treatment.
Balsam House, the residential treatment facility of Colorado Recovery in Boulder, also demonstrates the capacity to treat patients, some of whom are detained involuntarily, in a domestic, open-door setting.
The recently developed British hospital alternatives are very similar to Cedar House and Balsam House in that they are small (average capacity 8 beds), provide a fairly extended period of care (mean 38 days), have staff awake at night and accept compulsory admissions. A substantial proportion (16%) of patients are compulsorily admitted and most (60%) suffer from psychosis.
Treating people with respect in normalizing and domestic settings leads them to exercise… self control over their impulses
