Integration of nidotherapy into the management of mental illness and antisocial personality: a qualitative study.
BACKGROUND
Nidotherapy is a new treatment aimed at the systematic alteration of the environment in order to make a better fit for a person with chronic mental health difficulties. Preliminary work has suggested that it might have particular value in those with antisocial personality disorder.


OBJECTIVE
To examine the views of patients with mental illness combined with antisocial personality features about the acceptability and value of nidotherapy when given over a six-month period as an adjunct to conventional care.


METHODS
A two-phase study was used. First, a set of key informant interviews was carried out to determine how nidotherapy was perceived in order to identify potentially important themes. Specific topic guides derived from these themes were drawn up for use in the second stage of the study, involving semi-structured interviews with a sample of patients, members of their care teams and their nidotherapists. Nine patients were purposively selected to ensure that a range of demographic and clinical factors was covered.


RESULTS
Analysis of the results showed that the common threads of the perception of nidotherapy were that it was both feasible and acceptable to those with antisocial personality disturbance and that the nidotherapists were felt to be valuable allies in what was otherwise seen as a hostile world. It was also seen to improve adherence to other therapies. It was much less valuable when the staff on the clinical teams were not able to embrace the collaborative approach necessary with this therapy.


CONCLUSIONS
Nidotherapy is an acceptable form of management and was perceived in this study to have largely positive results for both patients and clinical teams as it offered intervention beyond that provided by conventional teams. It was felt to require more than six months of treatment and was less successful when there was inadequate communication between the nidotherapist and clinical teams and when the philosophy of care was not congruent.
Spencer
Sarah-Jane
SJ
West London Mental Health NHS Trust, London, UK. sarah-jane.spencer@nhs.net
Rutter
Deborah
D
Tyrer
Peter
P
D000328:Adult; D000374:Aggression / Q000523:psychology; D000987:Antisocial Personality Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D001291:Attitude of Health Personnel; D001714:Bipolar Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D003131:Combined Modality Therapy; D015897:Comorbidity; D003299:Cooperative Behavior; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D004739:England; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D007406:Interview, Psychological; D008297:Male; D010348:Patient Care Team; D010349:Patient Compliance / Q000523:psychology; D017060:Patient Satisfaction; D012559:Schizophrenia / Q000175:diagnosis / Q000628:therapy; D012565:Schizophrenic Psychology; D012960:Socioenvironmental Therapy / Q000379:methods*