Patients with complex emotional needs often experience severe, long-standing mental health difficulties, frequently rooted in complex trauma. Contemporary systems of care, however, rely on expedient and overly reductive diagnostic models that fail to capture patients’ true complexity. Increasing service demands, limited staffing, and inadequate resources for sustained, relationship-based interventions further strain psychiatric care. As a result, treatment becomes fragmented, and many vulnerable patients fall through gaps between services.
Others are frequently treated in pressured acute inpatient systems where risk is high, care pathways are fragmented, and restrictive practices can become the default. In severe cases, these patients are placed in restrictive environments for years, in order to keep them safe. By prioritising safety, such restrictions impact patient development around experiences of agency and responsibility that are centrally linked to the nature of their complex troubles.
This session introduces therapeutic community (TC) principles as an alternative, with real-world examples from The Cassel Hospital (UK), The Austen Riggs Center (US) and Springbank Ward (UK). We will focus on dynamics of managing risks through the non-restrictive containment of relationships as opposed to locks and prohibitions. We will also draw on principles of integrated and shared formulations, reflective staff processes, and neurodiversity informed adaptations as important foundations that support and further create safer, more humane alternatives to restrictive forms of care.
Service evaluation data from over 100 patient trajectories through Springbank’s one year programme will be used to illustrate how prior exposure to restrictions, medication use and trauma histories relate to incidents and discharge outcomes.
Speakers from UK and US therapeutic community settings (Cassel Hospital, Austen Riggs Center) and lived experience perspectives give an insight into their work and focus on how TC principles can be applied to work with patients with complex emotional needs in acute and outpatient mental health settings.
Learning objectives
By the end of this webinar you will be able to:
• describe core therapeutic community / relational principles (culture of enquiry, shared formulation, community-as-treatment) and how these reduce reliance on restrictive practice
• summarise outcomes and practical ingredients from a decade of non-restrictive care in a specialist high-risk inpatient programme (including trajectory-level learning)
• apply trauma-, attachment-, and neurodiversity-informed thinking to predict variation in engagement, escalation and discharge outcomes, and identify implications for ward/team practice
• identify safe, implementable "first steps" to translate these principles into acute wards/community teams, including ethical decision points (e.g., prescribing, boundaries, governance).
Speakers
Chair: Dr Pamela Peters, Cambridge and Peterborough NHS Foundation Trust, Cambridge and Peterborough
Dr Miriam Barrett, Cassel Hospital, Surrey
Dr Jorge Zimbron, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge
Dr Emin Erkal, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge
Dr John Azer, Austen Riggs Centre, USA
Ms Fi Kuhn-Thompson, Midlands Partner University NHS Foundation Trust, Stafford
Funding
RCPsych International Congress is financially supported by the purchase of exhibition stand packages. A full list of confirmed exhibitors can be found here: Exhibiting Organisations at International Congress 2026
Availability
This webinar is part of the Congress webinar 2026 package. If you attended all four days of Congress, you will have access to these as part of your Congress package. Otherwise the Congress webinar 2026 package can be purchased below.
