Chiesa & Fonagy (Reference Chiesa and Fonagy2000) clearly demonstrate the beneficial effects of therapeutic community treatment for personality disorder, and more so in the treatment limb with less hospitalisation and more day care.

The logical extension of this is to offer these programmes with only day care. Several units around the country are now doing this, including new units in Aberdeen and Maidstone, as well as long-established units such as our own in Reading and the Red House in Salford.

The evidence from systematic reviews and meta-analyses for the effectiveness of therapeutic communities in treatment of personality disorders is strong (Reference Lees and ManningLees & Manning, 1999) and, together with the Cassel study, demonstrates the need for new, creative ways of setting up effective treatment programmes.

A multi-centre research project funded by the National Lotteries Charities Board is now underway, which should help in this endeavour. It is using multi-level modelling and a path-analytic equation modelling technique to determine the impact of a number of features that therapeutic community programmes have. This research is more complex and sophisticated than a simple randomised controlled trial design, but for treatments that do not fit a drug model paradigm it will be much more helpful in designing effective programmes of therapy. The protocol is available at www.pettarchiv.org.uk/atc-protocol.htm.