I like that semi-patient-run idea. My contribution would be to make it less like a hospital. I've been wondering about how some of the ideas in place where I work could also be used with adults. I work at a residential treatment facility for teenage girls. It's more like a boarding school than it is like a hospital, except with closer supervision and more structure. The girls have very little free time - if they are not in school, they are in groups (which teach life skills, recreation, various educational topics, support groups such as for substance abuse, or co-dependency), or they are working on something. Of course they have therapy too - at least weekly and sometimes more, plus group sessions with the therapist. The residents do the cleaning, cooking, their own laundry. There are also service projects, oh, and the essay room, where the girls wind up as consequences if they aren't doing the program and following the rules. There are various jobs that residents get, which include running some of the groups, and doing the food orders. Upper level girls have some authority over the ones who haven't earned those levels yet, and can consequence other residents, and even occasionally supervise them with staff nearby but not right there watching everything. The girls who make it to the upper levels develop so much confidence, and leadership skills. I really admire them.

A lot of this stuff could be applicable in treating adults. Rather than removing people entirely from the realities of life, how about placing them in a supported environment where they continue to be responsible for themselves, and for others, and carry on with life's progression. Part of the program could include classes, as well as service, and why not paid work? Wouldn't that contribute to a greater sense of competence in the patients, as well as reducing costs? Of course, there would still need to be enough paid staff to supervise everyone and keep them safe, and keep them moving along in the program. Even someone needing one-on-one supervision could still participate in just about all of the activities, including work as appropriate.

Oh, and I'm not sure that higher salaries for staff would improve a program. I get $6 an hour for what I do, and I have a bachelors degree. Some of the girls talk about having made at least that much working in fast food. The other day, one of the girls asked me why I was working there, and I told her that I like being there, and I learn a lot, and feel that it's worthwhile, and also good experience. When I asked if she liked that answer, she told me that she likes to know that we aren't just working there for the money. Since they don't pay us that much, I could assure her that anybody working for the money would not stay very long. But the downside is, the turnover rate is high. Good staff get better offers someplace else, and can't afford not to leave. So, money is a necessary thing, but also not the solution either.

Just a few thoughts,
Wendy