Milieu therapy takes place in a safe, structured environment and aims to create behavioral changes and improve mental health and functioning.

Milieu therapy is a form of therapy in which the environment plays a key role in the treatment of mental illness. It aims to help people change their behaviors, learn coping strategies, and develop practical and social skills for functioning in everyday life.

Milieu therapy may involve group work, focusing on peer interactions and communication, and individual psychotherapy with healthcare professionals.

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Milieu therapy combines individual and group therapy in a structured, safe, supportive environment. The group may include healthcare professionals and people with similar conditions or challenges.

The main functionTrusted Source of milieu therapy involves a change of environment in which to improve a person’s health and behavior. It aims to reduce any maladaptive behaviors people may have and help them develop skills to cope with everyday life.

Milieu therapy also aims to ensure individual safety, support recovery, and encourage the development of positive social interactions between people.

Often, milieu therapy takes place in long-term care facilities to treat psychosis-related conditions. According to an older 2015 study, other settings may includeTrusted Source:

  • psychiatric hospitals and nursing wards
  • substance misuse treatment centers
  • community outpatient day programs
  • residential treatment centers

Daily structure

People will follow an organized structure for their day-to-day living. They may have group sessions with their peers and one-to-one sessions with healthcare professionals. These sessions aim to help people learn practical and social coping strategies.

Various healthcare professionals may deliver the therapy, including nurses, mental health professionals, or specialist milieu therapists.

Each of these professionals may have different roles during milieu therapy. They may haveTrusted Source nursing or social work training and may specialize in mental health.

Milieu therapy generally lacks hierarchy, emphasizing individual responsibility, peer interaction, and open communication with healthcare professionals.

Milieu therapy may vary with each facility and type of illness it is treating but may includeTrusted Source:

  • structured activity schedules for daily living, including:
    • meals
    • physical exercise
    • rest
    • activities such as music or art
  • psychotherapy, in which people talk with a healthcare professional to express feelings and receive feedback on behavior
  • group therapy and peer interaction for people to practice the tools and skills they are developing

Some of the key principles of milieu therapy includeTrusted Source:

  • Safe, structured environment: This includes providing clear rules and boundaries, a structured activity schedule and routine, and removing any potentially harmful items, such as sharp objects, from the environment.
  • Positive reinforcement: Recognizing and providing positive feedback for adaptive behavior.
  • Personal responsibility: Milieu therapy focuses on learning positive coping strategies, managing conflict, and following routines and schedules.
  • Social interaction: Milieu therapy emphasizes interactions with peers and healthcare professionals within the group setting. It encourages people to develop and put into practice social and interpersonal skills.

Milieu therapy is a treatment for mental health illnesses. This may include conditions such as:

Milieu therapy may also be an option for children with language disabilities to help treat communication impairment and a potential treatment for adults with severe intellectual disability.

The effectiveness of milieu therapy may depend on the individual and their condition, as each person may respond to the treatment differently.

According to an older 2016 studyTrusted Source, criticism of milieu therapy includes the lack of any clear definition for milieu therapy. This means it is difficult to measure the effects of the treatment for people with mental illness.

A 2020 studyTrusted Source looked at the effectiveness of milieu therapy in reducing conflict behaviors in people with schizophrenia.

The study included 100 people with schizophrenia who were in acute psychiatric wards. Half the participants received milieu therapy and routine hospital treatment, while the control group received only routine hospital treatment.

The group receiving milieu therapy presented reduced aggressive, self-harm, and rule-breaking behaviors than the control group.

Potential benefits of milieu therapy may include:

  • empowering people to be active participants in their treatment and recovery
  • helping support people to become productive members of society
  • creating a healing environment through structured group activities
  • monitoring and control of self-harming or suicidal behaviors
  • helping to develop interpersonal skills and coping strategies to manage symptoms in everyday life

However, the study authors stated that more research is necessary to understand and demonstrate the benefits of milieu therapy.

Help is out there

If you or someone you know is in crisis and considering suicide or self-harm, please seek support:

  • Call or text the 988 Lifeline at 988 or chat at 988lifeline.org. Caring counselors are available to listen and provide free and confidential support 24/7.
  • Text HOME to the Crisis Text Line at 741741 to connect with a volunteer crisis counselor for free and confidential support 24/7.
  • Not in the United States? Find a helpline in your country with Befrienders Worldwide.
  • Call 911 or your local emergency services number if you feel safe to do so.

If you’re calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely.

If you’re not in the same household, stay on the phone with them until help arrives.

According to the 2016 studyTrusted Source, one limitation of milieu therapy is the lack of a clear definition and medical guidelines around the therapy.

Milieu therapy may vary widely between different facilities and healthcare professionals. This means that the quality of the treatment may depend on where it takes place and who delivers it.

According to a 2019 studyTrusted Source, some mental health professionals have reported feeling vulnerable and unsafe in some situations of milieu therapy.

Sometimes, it may be difficult to establish clear boundaries with service users, and some healthcare professionals may feel unsafe meeting with some people in certain situations, particularly if working one-on-one.

If people want to learn more about milieu therapy and how to access it, they can talk with a doctor or mental health professional.

People having milieu therapy can also talk with a healthcare professional if they experience problems or feel it is not working for them.

A healthcare professional can suggest alternative therapies and treatments if milieu therapy is ineffective.

Milieu therapy uses the environment a person is in to help change maladaptive behaviors and develop life skills and coping strategies.

Milieu therapy is a potential treatment for mental health issues. Therapy may include group and individual sessions with peers and healthcare professionals. However, specific treatment guidelines may vary from facility to facility.

Anyone considering whether milieu therapy could be an option for them can talk with a doctor or mental health professional.